An increasing trend of iatrogenic scar endometriosis after lower segment cesarean section


An increasing trend of iatrogenic scar endometriosis after lower segment cesarean section


Nishat Fatema1*, Dil Anziz Begum1, Shirin Fatema1, A.K.M Arif Uddin Ahmed2

1Department of Obstetrics & Gynecology, Imperial Hospital Limited, Chattogram Bangladesh
2Academic Coordinator Imperial Hospital Limited, Chattogram Bangladesh


International-Journal-of-Case-Reports-2d code

Cesarean scar endometriosis is an uncommon disorder developed due to iatrogenic implantation of endometrial tissues in the cesarean incision site. The frequency of the scar endometriosis is assumed to increase because of the increasing trend of lower segment cesarean section in modern obstetric practice. Cesarean section might be a great risk factor for the development of scar endometriosis due to higher exposure of endometrial cells to the subcutaneous tissue during the procedure. Prevention of decidual cell contamination to the superficial abdominal layers may reduce the occurrence of iatrogenic scar endometriosis. We reported a 21-year old para 2 woman with a history of cesarean section 2.5 years back who presented with a small mass at the middle of the cesarean scar which was associated with pain and blood-stained discharge during menstruation. Based on clinical and USG findings the provisional diagnosis was made scar endometriosis and subsequently we managed her by wide local excision of the lesion followed by adjuvant hormone therapy. No recurrence of scar endometriosis was observed during her follow up period.


Keywords: Endometriosis; Scar; Cesarean; Iatrogenic Disease (Mesh terms)


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How to cite this article:

Nishat Fatema, Dil Anziz Begum, Shirin Fatema, A.K.M Arif Uddin Ahmed. An increasing trend of iatrogenic scar endometriosis after lower segment cesarean section. International Journal of Case Reports, 2020 4:117. DOI: 10.28933/ijcr-2020-01-1505


References:

1. Zhang P, Sun Y, Zhang C, et al. Cesarean scar endometriosis: Presentation of 198 cases and literature review. BMC Womens Health. 2019;19(1). doi:10.1186/s12905-019-0711-8
2. Tatli F, Gozeneli O, Uyanikoglu H, et al. The clinical characteristics and surgical approach of scar endometriosis: A case series of 14 women. Bosn J Basic Med Sci. 2018;18(3):275-278. doi:10.17305/bjbms.2018.2659
3. Sedhain N, Dangal G, Karki A, et al. Caesarean Scar Endometriosis. J Nepal Health Res Counc. 2018;15(3):292-294. doi:10.3126/jnhrc.v15i3.18859
4. Khanani K. Scar Endometriosis: An Entity Not to Be Forgotten. Vol 67.; 2017. https://ecommons.aku.edu/pakistan_fhs_mc_radiol. Accessed November 14, 2019.
5. Alnafisah F, Dawa SK, Alalfy S. Skin Endometriosis at the Caesarean Section Scar: A Case Report and Review of the Literature. Cureus. January 2018. doi:10.7759/cureus.2063
6. Khachani I, Filali Adib A, Bezad R. Cesarean Scar Endometriosis: An Uncommon Surgical Complication on the Rise? Case Report and Literature Review. Case Rep Obstet Gynecol. 2017;2017:1-4. doi:10.1155/2017/8062924
7. Kocher M, Hardie A, Schaefer A, McLaren T, Kovacs M. Cesarean-section scar endometrioma: A case report and review of the literature. J Radiol Case Rep. 2017;11(12):8-15. doi:10.3941/jrcr.v11i12.3178
8. Yıldırım D, Tatar C, Doğan O, et al. Post-Cesarean scar endometriosis. Turk Jinekoloji ve Obstet Dern Derg. 2018;15(1):33-38. doi:10.4274/tjod.90922
9. Francica G, Scarano F. Delayed diagnosis is associated with changes in the clinical and ultrasound features of subcutaneous endometriosis near cesarean section scars. J Ultrasound. 2009;12(3):101-106. doi:10.1016/j.jus.2009.05.004
10. García-Gavilán M del C, Fernández-Pérez F, Hinojosa-Guadix J, González-Bárcenas ML. Rectus abdominal endometriosis on cesarean scar. Gastroenterol y Hepatol (English Ed. 2016;39(5):341-343. doi:10.1016/j.gastre.2016.04.001
11. Goel P, Devi L, Tandon R, Saha PK, Dalal A. Scar endometriosis – A series of six patients. Int J Surg. 2011;9(1):39-40. doi:10.1016/j.ijsu.2010.08.003
12. Nigam J, Omhare A, Sharma A. Fine-needle aspiration cytology of a cesarean scar endometriosis. Tzu Chi Med J. 2017;29(4):232-234. doi:10.4103/tcmj.tcmj_37_17
13. Akdemir A, Akman L, Yavuzsen HT, Zekioglu O. Clinical features of patients with endometriosis on the cesarean scar. Kaohsiung J Med Sci. 2014;30(10):541-543. doi:10.1016/j.kjms.2013.12.001
14. Ding DC, Hsu S. Scar endometriosis at the site of cesarean section. Taiwan J Obstet Gynecol. 2006;45(3):247-249. doi:10.1016/S1028-4559(09)60234-5
15. Nominato NS, Prates LFVS, Lauar I, Morais J, Maia L, Geber S. Caesarean section greatly increases risk of scar endometriosis. Eur J Obstet Gynecol Reprod Biol. 2010;152(1):83-85. doi:10.1016/j.ejogrb.2010.05.001
16. Reddi Rani P, Soundararaghavan S, Rajaram P. Endometriosis in abdominal scars – review of 27 cases. Int J Gynecol Obstet. 1991;36(3):215-218. doi:10.1016/0020-7292(91)90716-I