Scar endometriosis: A case report of a rare complication of laparotomy for ectopic pregnancy

Abstract

Background: The presence of endometrium outside the uterine cavity is known as endometriosis. Scar endometriosis is an endometriosis present in or connected to a previous scar and is a relatively rare entity. Generally, a history of prior laparotomy, mostly cesarean section, is elicited. Case Report: A 28-year-old female, Para-2 Live-2 with exploratory laparotomy for ectopic pregnancy; presented to our hospital with a complaint of pain in the abdomen during menses for the past 1 year. She also complained of swelling in the lower abdomen since 10 months. She had two normal vaginal deliveries and history of exploratory laparotomy 3 years back for ruptured ectopic pregnancy of 2 months. A curved incision was placed around the nodule The nodule of around 3 cm × 2 cm was excised from the subcutaneous tissue extending up to the right rectus muscle and the defect was repaired with Vicryl 2-0 RB and closure of fat plane and skin was performed. Discussion: Scar endometriosis is an infrequent type of extrapelvic endometriosis. The incidence of scar endometriosis is 0.03–0.15% of all cases of endometriosis. The generally accepted hypothesis for scar endometriosis is “Iatrogenic/accidental implantation of endometrium in the wound during a laparotomy/laparoscopy”. Ultrasonogram (USG) scan and computerized tomography (CT) scan would ascertain the diagnosis in most cases and also act as guiding tools for fine-needle aspiration of such masses; especially to exclude malignancy. Management generally involves a wide local excision of the lesion. Sometimes, surgical excision may be combined with postoperative adjuvant therapy like gonadotropin-releasing hormone (GnRH) analog or dienogest. Primary prevention is always better than treating it later. Conclusion: To conclude, we can say that women presenting with a painful nodule near any laparotomy scar with cyclical/continuous pain which increases in size during the menstruation cycle should be suspected of scar endometriosis.