Abdominal scar endometriosis

Abdominal scar endometriosis is an uncommon pathology. It can occur in any abdominal scar, most often after a surgical procedure on the uterus.

The purpose of this study is to highlight the potential pitfall in the diagnosis of this disease.

This retrospective study reviewed all cases of proven abdominal scar endometriosis seen in a 5-year period (2002-2006) in our hospital, noting the demographic data of the patients and management. They were all treated by the same surgeon and also had histopathological confirmation of the lesion.

A total of 14 women were treated during this period. They were all pre-menopausal. The mean age was 29.1years (range 20 to 42). Presenting symptoms included painful 'heaped-up' scars and cyclical pain related to their menstrual periods. They were referred to the general surgical clinic with various diagnoses such as incisional hernia, granuloma, keloid scar etc. All the patients had history of previous surgical procedures on the uterus for various indications. Treatment was a wide excision of the lesion with apposition of the edges only. Specimens were examined histologically and confirmed to be endometriosis. The follow up periods were rather short as the patients stopped to attend the hospital. During this period, there was no recurrence or wound break-down.

Although scar endometriosis is a rare entity, a good and diligent surgical history and a high index of suspicion are the keys for a pre-operative diagnosis.