THE SKARY SCARY TUNNEL – A CASE FILE ON SCAR ENDOMETRIOSIS

Background: Scar endometriosis is an uncommon variant of extrapelvic endometriosis characterised by the implantation of endometrial tissue in surgical scars, predominantly after caesarean sections. The clinical appearance frequently resembles other benign abdominal wall disorders, resulting in common misdiagnosis and postponed treatment. Objective: To assess the clinical features, diagnostic methods, and surgical results in a cohort of patients with histologically verified scar endometriosis. Methods: A retrospective case series was performed at a tertiary care facility comprising eight women who exhibited abdominal wall symptoms next to previous obstetric surgery scars. Clinical data encompassing age, parity, obstetric history, symptom duration, lesion features, imaging modality, treatment, and histological confirmation were examined. The diagnosis was determined through imaging (ultrasound/MRI) and validated by histological analysis following excision. Results: The average age of the patients was 27.5 years, with each having experienced at least one caesarean section. The average duration of symptoms was 10.6 months. Lesions were predominantly situated on the right side of the surgical scar, averaging 2 cm in size. Ultrasonography was employed in five individuals, while MRI was utilised in three for diagnostic assessment. Six individuals underwent surgical excision, whereas two were treated medically. Histopathological analysis verified the presence of endometrial glands and stroma in all removed specimens. No recurrence was noted during the follow-up period. Conclusion: Scar endometriosis must be contemplated in women exhibiting cyclical discomfort and oedema adjacent to surgical scars, particularly following a caesarean section. Surgical excision with sufficient margins is the conclusive treatment. Heightened awareness and prompt diagnosis are essential to avert superfluous procedures, recurrence, and possible malignant change.

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