January28, 2023

Abstract Volume: 6 Issue: 5 ISSN:

Rare Case of Caesarean Scar Cystic Endometriosis

Dr Raheela Naz1*, Ammara Saeed2, Dr Azhar Schett3

 

  1. Clinical fellow, Wrexham Maelor Hospital, UK
  2. Sonography student at Michener institute of education Toronto
  3. Consultant, Sulaiman Al-Habib Hospital DHCC U.A.E.

 

Corresponding Author: Dr Raheela Naz, Clinical fellow, Wrexham Maelor Hospital.

Copy Right: © 2022 Dr Raheela Naz, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

 

Received Date: December 05, 2022

Published Date: December 07, 2022
DOI: 10.1027/marcr.2022.0285

 

Abstract

Caesarean scar endometriosis is a rare form of endometriosis. It has an incidence of 0.03%–0.4%. It might cause abdominal swelling and pain with cyclic changes during menstruation. We present a case of a lady who previously had two caesarean sections. Five years after her last caesarean section she started having pain in lower abdomen mostly at caesarean scar site .Ultrasound aided the diagnosis and she was treated successfully by surgical excision. Histology showed cystic endometriosis. This case report highlights the importance of early diagnosis and treatment of scar endometriosis before it starts affecting the quality of life, and also sheds light on the importance of confirming the diagnosis by histology as a malignant transformation has been reported although it remains rare.

Key Words: Endometriosis, Caesarean scar endometriosis.

Rare Case of Caesarean Scar Cystic Endometriosis

Introduction

Caesarean scar endometriosis (CSE) is a rare form of endometriosis. The condition has an incidence of 0.03%–0.4%. It may cause abdominal swelling and pain with cyclic changes during menstruation. Scar endometriosis typically results from the implantation of normal endometrial tissues after gynecological or obstetric surgeries. Malignant transformation has been reported but it remains rare. [3]

 

Case Presentation

We report a case from Dubai, United Arab Emirates. The patient previously had two caesarean sections. She presented with lower abdominal mostly at caesarean scar site. The pain was severe during periods but it was persisting for most of the days of the month. On examination, there was tenderness in the lower abdomen at the caesarean scar site, but there was no obvious swelling or discoloration of skin. Symptoms started five years after her second caesarean section. And   she felt that due to persistent pain and tenderness her daily routine activities were being affected and it was also affecting her quality of life. Ultrasound of the abdominal wall exhibited a cystic lesion on the rectus sheath on the right of the midline. Ultrasound was performed few months before surgery. (See figure 1&2)

Given the patient’s wishes, non-surgical approach was chosen( hormonal treatment) but her symptoms didn't improve. And after a discussion with the patient regarding surgical management, a decision was made to excise the lesion. Operative findings showed that on the right side of the caesarean scar, a 3cm cystic lesion was seen which was strongly adherent to the rectus sheath. The lesion was removed along with part of the rectus sheath as it was not possible to remove the swelling completely without excising part of the rectus sheath. Histology revealed cystic endometriosis, hemorrhage, and inflammation. No atypical nor malignant changes were seen. (See figure 3) The patient was examined in the Department of Obstetrics and Gynecology and did not find any recurrence in the first 2 years of follow-up.

 

Discussion

For patients who develop endometriosis, the majority of them had undergone a Pfannenstiel incision, and a minority had a vertical midline incision. [1] The imaging modality of choice for diagnosis is ultrasonography. The differential diagnosis can be hematoma, granuloma, and desmoid tumour. Histology is the assurance of diagnosis. It is satisfied if endometrial glands, stroma, and hemosiderin pigment are seen. The incidence of concomitant pelvic endometriosis with scar endometriosis has been reported to be from 14.3% to 26%.[2]

 

References

  1. Zhang P, Sun Y, Zhang C, Yang Y, Zhang L, Wang N, Xu H. Cesarean scar endometriosis: presentation of 198 cases and literature review. BMC Womens Health. 2019 Jan 18;19(1):14. doi: 10.1186/s12905-019-0711-8. PMID: 30658623; PMCID: PMC6339338.

  2. Cihangir Uzunçakmak, Ahmet Gülda?, Hasene Özçam, Kemal Dinç, "Scar Endometriosis: A Case Report of This Uncommon Entity and Review of the Literature", Case Reports in Obstetrics and Gynecology, vol. 2013, Article ID 386783, 4 pages, 2013. https://doi.org/10.1155/2013/386783

  3. Wei CJ, Huang SH. Clear cell carcinoma arising from scar endometriosis: A case report and literature review. Ci Ji Yi Xue Za Zhi. 2017 Jan-Mar;29(1):55-58. doi: 10.4103/tcmj.tcmj_11_17. PMID: 28757766; PMCID: PMC5509184.

 

Figure 1

Figure 2

Figure 3