Abstract:
Introduction. Cesarean scar endometriosis (CSE) is a rare form of endometriosis that occurs due to
previous surgical scars from obstetrical or gynecological procedures. The incidence of scar endometriosis
after cesarean section is reported to be 0,03-0,45%, and it may cause long-term discomfort and cyclic lower
abdominal pain.
Case presentation. A 43-years-old multiparous woman came to our hospital complaining of a painful lump
in the post-operative scar projection after a cesarean section with approximate sizes of 60x70 mm, which
appeared 7 years ago but has increased significantly in the last year. Ultrasounds findings show a solid
heterogeneous mass in hypogastric region extending from the lower region of the umbilicus to the
projection of post-operative scar on the abdominal wall, immediately posterior to the subcutaneous adipose
tissue in the projection of the muscle plane on the midline, measured 80x90x50x20 mm with moderate
neovascularization in the interior. In February 2022, was performed mass resection, intraoperatively a solid
infiltrate was detected in the aponeurosis, which was separated from the subcutaneous tissue, muscle, and
peritoneum. Histological examination confirms fibromuscular tissue fragments with endometriosis
outbreaks.
Discussion. Abdominal wall endometriosis is largely related to the previous history of surgery, especially
cesarean section and early hysterectomy. There is a combination of theories that best explains the
pathogenesis of abdominal wall endometriosis: direct implantation during a surgical procedure on the
endometrium or transportation to a cesarean section scar via lymphatic or hematogenous routes. The tissue
implants either proliferate under the same hormonal stimulation as the endometrium in the uterus or induce
metaplasia of the surrounding fascial tissue to form an endometrioma. Scar endometriosis may occur
months and even years after surgery, and initially can be asymptomatic. Medical therapy is generally
ineffective, and surgical resection of the scar endometrioma remains the mainstay of treatment. Because of
the possible recurrence and malignant degeneration of this disease, in our case, there was performed a large
surgical excision, with subsequent tissue reconstruction.
Conclusion. Scar endometriosis is a rare disorder in which both stromal tissue and functional endometrial
glands are seen outside the uterine cavity. It should be suspected in any female patient with a lump in the
surgical scar, which becomes more painful and swollen during the menstrual period.
