Caesarean Section Scar Endometriosis: a Case Report with Images
CANSAGE ePoster Library. Ngan T. 09/26/19; 275254; eP-121
Dr. Tin Yan Tina Ngan
Dr. Tin Yan Tina Ngan
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Endometriosis is defined as the presence of endometrial glands and endometrial stromal cells outside the endometrial cavity. Although common locations include ovaries, uterosacral ligaments and posterior cul-de-sac, endometriosis implants can also occur at incisional scars resulting from endometriosis surgeries or surgeries with endometrial manipulation. We report a case of caesarean scar endometriosis. Ultrasound images, magnetic resonance imaging (MRI) pictures, pathology photos, as well as histology slides are presented. The patient is a twenty-eight-year-old woman presenting with painful masses on bilateral sides of her Pfannenstiel incision. She has a previous history of three caesarean sections and hysteroscopic sterilization by tubal occlusion. She is known for endometriosis. The masses are more tender and increase in size during menstruation. MRI and ultrasound findings are consistent with abdominal wall endometriosis. The patient was consented for laparotomy and excision of the nodules. Pathology revealed dense fibrous and fibrofatty tissue accompanied by endometrial stromal cells with mononuclear inflammatory cells, confirming the diagnosis of endometriosis. Both nodules were resected and were sliced open in the operating room, revealing multiple endometriosis implants of brownish colour. Although caesarean section scar endometriosis is a rare event, the diagnosis can be made based on clinical symptoms of painful masses that increase in size along the incision during menstruation. Ultrasound and MRI can be performed for further evaluation. Surgical resection is an effective treatment.
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