Cesarean Section Scar Endometriosis: A Case Report From Sudan

Cesarean scar endometriosis is a rare form of endometriosis characterized by the presence of functional endometrial tissue within a surgical scar. Diagnosing this condition is challenging, as it is frequently misdiagnosed as granulomas, hernias, abscesses, hematomas, or neoplasms. The classic triad of symptoms includes a positive surgical history, cyclical pain, and a mass at the surgical scar. The presented case highlights the pivotal role of imaging modalities such as MRI, along with histopathological confirmation, in establishing a definitive diagnosis. Surgical excision with clear margins is the mainstay of treatment and remains superior to medical therapy in terms of long-term outcomes. Diagnosis relies on a high index of clinical suspicion. Clinical evaluation, along with ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI), aids in diagnosis. Surgical intervention is the definitive treatment, providing specimens for histopathological confirmation. We report the case of a 27-year-old woman with a history of one cesarean delivery who presented with a progressively enlarging, painful mass over her lower abdominal scar. The pain was cyclical and associated with menstruation. MRI revealed a heterogeneous mass not reaching rectus sheath. Surgical excision of the lesion was performed, and histopathological examination confirmed the diagnosis of endometriosis. The patient recovered uneventfully, with complete resolution of symptoms and no recurrence at six-month follow-up. This case highlights the importance of considering scar endometriosis in women with a history of cesarean section who present with cyclical pain and a mass at the scar site. Early recognition and surgical excision are essential for symptom relief and to prevent recurrence. Increased clinical awareness is crucial to avoid misdiagnosis and unnecessary delays in treatment.