Hidden in the Scar: A Rare Case of Episiotomy Scar Endometriosis

Authors

  • Ramya B
  • Nidhi Sharma
  • Evangeline Christable

Keywords:

N\A

Abstract

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.

Downloads

Download data is not yet available.

References

Giudice, L. C. (2010). Clinical practice. Endometriosis. New England Journal of Medicine, 362(25), 2389-98.

Horton, J. D., Dezee, K. J., Ahnfeldt, E. P., & Wagner, M. (2006). Abdominal wall endometriosis: a surgeon's perspective and review of 445 cases. The American Journal of Surgery, 192(4), 407-12.

Díaz-Valdivia, N., Toro-Castaño, I., & Aranda-Romo, S. (2020). Endometriosis in surgical scars: Case report and review of the literature. Annals of Medicine and Surgery, 60, 273-7.

Nominato, N. S., Prates, L. F., Lauar, I., Morais, J., Maia, L., & Geber, S. (2010). Caesarean section greatly increases risk of scar endometriosis. European Journal of Obstetrics & Gynecology and Reproductive Biology, 152(1), 83-5.

Steck WD, Helwig EB. Cutaneous endometriosis. Clin Obstet Gynecol. 1966;9(2):373–83.

Agarwal N, Subramanian A. Endometriosis - morphology, clinical presentations, and molecular pathology. J Lab Physicians. 2010;2(1):1–9.

Zhao X, Lang J, Leng J, Liu Z, Sun D, Zhu L. Abdominal wall endometriomas. Int J Gynaecol Obstet. 2007;97(3):208–12.

Medeiros FD, Cavalcante DI, Medeiros MA, Eleutério J Jr. Fine-needle aspiration cytology of scar endometriosis: a study of 10 cases and literature review. Diagn Cytopathol. 2011;39(1):18–21.

Choudhary S, Fasih N, Papadatos D, Shanbhogue AK. Uncommon locations of endometriosis: A pictorial review. Am J Roentgenol. 2009;192(6):1636–44.

Blanco RG, Parithivel VS, Shah AK, Gumbs MA, Schein M, Gerst PH. Abdominal wall endometriomas. Am J Surg. 2003;185(6):596–8.

Clement PB. Pathologic manifestations of endometriosis. Surg Clin North Am. 1997;77(2):413–34.

Stern RC, Dash R, Bentley RC, Snyder MJ, Haney AF, Robboy SJ. Malignancy in endometriosis: frequency and comparison of ovarian and extraovarian types. Int J Gynecol Pathol. 2001;20(2):133–9.

Bektaş H, Bilsel Y, Sari YS, Ersöz F, Koç O, Deniz M, et al. Abdominal wall endometriosis: a 10-year experience and brief review of the literature. J Surg Res. 2010;164(1):e77–81.

Mishra, S.R., Randive, A. & Desai, G.S. Perineal Scar Endometriosis Post Forceps Vaginal Delivery. J Obstet Gynecol India 2024;74, 466–468. https://doi.org/10.1007/s13224-023-01870-9

Xu, S., Wang, W. & Sun, L.P. Comparison of clear cell carcinoma and benign endometriosis in episiotomy scar - two cases report and literature review. BMC Women's Health 20, 11 (2020). https://doi.org/10.1186/s12905-020-0880-5

Güngör ND, Gürbüz T, Demir MK, Sağiroğlu J. Endometriosis in an episiotomy scar: Case report. Türk Üreme Tıbbı ve Cerrahisi Dergisi. 2018;2(1):30–4. doi:10.24074/tjrms.2018-59935

Downloads

Published

2025-05-22

How to Cite

1.
B R, Sharma N, Christable E. Hidden in the Scar: A Rare Case of Episiotomy Scar Endometriosis. J Neonatal Surg [Internet]. 2025May22 [cited 2025Sep.21];14(26S):788-91. Available from: https://jneonatalsurg.com/index.php/jns/article/view/6357