Case report: Caesarean scar endometriosis - A rare entity

Caesarean scar endometriosis (CSE) is a rare form of endometriosis due to previous surgical scars from obstetrical and gynecological procedures. The incidence of CSE was 0.08% and quite difficult to diagnose.

A 37-year-old multiparous woman came with intermittent pain in her lower left abdominal region and lump with a bluish color and solid consistency on the left side of the caesarean scar. Ultrasounds findings show a solid mass, measured 45 × 40 × 39 mm with neovascularization color score: 4. In April 2021, we performed mass resection, intraoperatively we found solid mass with no adhesion and infiltration found. Histological examination results confirm external endometriosis from the mass and the fascia was free from endometriosis. The symptoms reported relief after the procedure.

Scar endometriosis is largely related to previous abdominal surgery like caesarean section, the mass increase in size during menses and becomes symptomatic. CSE develop ranging 12 months to 21 years and could mimic other hernias or tumor, that's why careful and precise examination is needed. The imaging modality we use in this case was ultrasonography which is the best and most accessible, reliable and cost-effective to diagnose. We performed large surgical excision of the lesion with reconstruction of damaged tissue to prevent recurrence and conversion to malignancy.

Caesarean scar endometriosis should be considered in women of reproductive age with lower abdominal pain and/or mass at the caesarean scar from previous delivery or following obstetric-gynecologic surgery.