Hidden in the Scar: A Rare Case of Episiotomy Scar Endometriosis
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N\AAbstract
Episiotomy scar endometriosis is a rare clinical condition characterized by the presence of functional endometrial tissue within a scar, often presenting as cyclical pain and swelling. This report details a case of a 29-year-old woman with a two-year history of cyclic perineal pain and swelling, linked to a tender nodule at the distal end of a prior episiotomy scar. Despite prior medical therapy, the symptoms persisted. Imaging confirmed a multiloculated lesion consistent with a soft tissue mass, and surgical excision was performed. Histopathological analysis revealed endometrial glands and stroma with hemosiderin-laden macrophages, confirming the diagnosis. Postoperative follow-up showed complete symptom resolution, emphasizing the effectiveness of surgical excision. This case highlights the diagnostic challenges of scar endometriosis due to its nonspecific symptoms, with imaging and histopathology playing key roles in confirmation. The report reviews pathophysiology, diagnosis, and management strategies, showing the need for heightened clinical suspicion, especially in patients with prior obstetric procedures. Additionally, it contributes to the sparse literature on extrapelvic endometriosis, illustrating the importance of early recognition and definitive management to prevent recurrence and improve patient outcomes. Regular follow-up remains essential to ensure long-term success and monitor for potential complications.
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