Poster Session

P77. Abdominal scar endometriosis after caesarean section : a case report

Nahid Yasmin (BD), Shahrin Ahmed (BD)

[Yasmin] Mugda Medical College, [Ahmed] Green Life Medical College

Context: The presence of functional endometrial tissue outside the uterine cavity in the vicinity of scar is described as scar endometriosis. It is a rare disease. It usually occurs in patients who had a history of gynecological or obstetrical surgery in past. Objectives: To diagnose scar endometriosis and evaluation of management strategy in patients of scar endometriosis. Case report: A 32 years old Bangladeshi woman was seen in consultation for a painful abdominal scar. She was otherwise healthy woman with no significant medical history. Her surgical history included an uncomplicated caesarean section eleven years previously. She complained of increasing pain and tenderness at the pfannenstiel incisional site and cyclical pattern associated with these symptoms. Physical examination revealed a well healed caesarean scar with a non mobile, nodular, moderately pigmented area at its lateral border. Exquisite point tenderness to palpation over the nodular area was noted and the patient was taken to the OT for exploration of the abdominal wound and possible neuroma excision. Intraoperatively extensive fibrosis of the scar to the fascia was noted. The scar was completely excised with the nodular portion and the specimen was sent to the pathology department. Result: The final report revealed 'Dermal fibrosis with endometriosis'. The patients postoperative course was uneventful and her pain subsided. Conclusion: Scar endometriosis is a rare and often elusive diagnosis that can lead to both patient and physician frustration. One should maintain a high level of suspicion in any woman presenting with pain at an incisional site , most commonly following pelvic surgery. A thorough history and physical examination should always be performed and every surgeon should consider this entity in their differential diagnosis.