Incisional endometriosis: A rare cause for a painful scar – A report and commentary
A 25-year-old P1L1 lady presented with a 8-month-old mass over her anterior abdominal wall. She complained of incapacitating pain in the swelling, which started a week before menstruation and subsided a week after her periods. She also reported a corresponding fluctuation in the size of the swelling during each cycle. The patient had undergone LSCS 5 years earlier.\nOn examination, the swelling was found to be located on the left side of the anterior abdominal wall, close to the previous Pfannenstiel incisional scar. It measured 4 × 4 cm, was firm, had well-defined borders, and was situated in the subcutaneous plane. There was no clinical or sonological evidence of pelvic endometriosis.\nSurgical excision was performed, leaving a wide margin on all sides. Perioperatively, swelling was found attached to the anterior rectus sheath, part of which was also excised. The rectus sheath defect measuring 3 × 2 cm was repaired with number Prolene #1 suture. The recovery was uneventful.\nGrossly, the excised specimen was an irregular fibro-fatty mass, which on cut section showed a nodular tissue grayish-white in colour with multiple cysts []. Histopathology revealed fibro adipose tissue with scattered endometrial glands surrounded by endometrial stroma []. These features confirmed the diagnosis of IE. The patient was followed for 6 months after the excision. She was completely relieved of her symptoms by then.