Incisional endometriosis after cesarean section, episiotomy and other gynecologic procedures

Aim: To report 11 cases of incisional endometriosis after cesarean section, episiotomy and other gynecologic procedures. The diagnostic approaches and therapies for incisional endometriosis are also evaluated. Methods: Eleven patients who presented with a painful nodule that was increasing in size during menstruation on the scar of a previous gynecologic procedure were examined retrospectively. Results: All patients presented with a palpable painful lesion, located on the cesarean section incision, perineal episiotomy incision or the vaginal cuff after hysterectomy. All masses were increasing during menstruation and all patients had been having cyclical pain that worsened during menstrual periods. The mean age of the patients was 28.2 years. The onset of symptoms was referred at variable intervals after surgery ranging between 2 and 11 years (mean: 5.72 years). Ultrasound examination confirmed hypoechoic mass septated with cystic and solid components in the abdomin without intra-abdominal communications. All endometriotic masses were completely excised under general anesthesia. The excised masses were sent for microscopic examination which confirmed the diagnosis of endometriosis. Conclusion: Incisional endometriosis seems to be common in women who have had a cesarean section, although it does occur after other procedures and de novo. It is suggested that caution is exercised during gynecologic procedures to avoid transplantation of endometrium to the anterior abdominal wall. The preferred management is to excise the lesion completely even if this necessitates fascial excision.