[Endometriosis in delayed scarring of postpartum eutocic episiorrhaphy. Integral aspects and a case report]

Endometriosis remains a mystery because it has not yet been shown why these cells are viable in the abdominal cavity, although it has been thought that the immune system plays a role in implantation outside the intrauterine cavity by abasement in the regulatory capacity of natural killer cells, as well as peripheral and peritoneal immunologic cells. Among methods used to recognize this illness are laparoscopy, laparotomy, ultrasound, antibodies, and the histologic study. It has been observed that surgical scars can present cyclical inflammation and pain when affected with this pathology. We present the case of a patient with a second delivery who arrived at the Gynecology Service due to referring intense pain in the episiorrhaphy scar as well as superficial dyspareunia. One year after performance of the surgical procedure, pain did not allow the patient was unable to sit normally; in addition, during the last 3 months the area of the cicatrix augmented in volume during menstruation. Under peridural block and with surgical spindle excision, the abnormal tissue was dissected without complications; the surgery showed brittle tissue and with abundant new vascularity. The histologic diagnosis reported vulvar-tissue endometriosis. Was initiate complementary treatment was initiated with gestrinon once a week for 4 weeks, as well as danazol daily for 2 months to avoid possible persistence of endometrial tissue. The scar at present is minimal and is observed along the borders of the surgical union line, without an increase in size nor discomfort on digital pressure. We consider it necessary to assure cleaning of the episiotomy before initiating surgical suturing to diminish presence of endometriosis, despite the fact that incidence of this disturbance is low (0.03%). Advancement in knowledge of the physiopathology process will permit elimination of the remaining endometrial tissue with new therapeutic strategies, as well as clearing up the mechanism of ectopic implantation of endometrial cells.