A Classical Case of Cesarean Scar Endometriosis in a 35-Year-Old Woman Presenting with Cyclical Abdominal Pain: A Case Report

Patient: Female, 35-year-old Final Diagnosis: Cesarean scar endometriosis Symptoms: Bleeding over lump in cesarean section scar • cyclical abdominal pain • hyperpigmentation of skin • mass in cesarean scar Clinical Procedure: Surgical excision of lump Specialty: Obstetrics and Gynecology OBJECTIVE: Rare disease BACKGROUND: This report details the case of a 35-year-old woman who presented with cyclical abdominal pain diagnosed as cesarean scar endometriosis. Scar endometriosis is a phenomenon that occurs after abdominal/pelvic procedures like cesarean sections; after which, it is called cesarean scar endometriosis. It is frequently misdiagnosed as hernias, granulomas, abscesses, hematomas and neoplasms, and thus needs proper investigation to diagnose. The classic triad of symptoms are a positive surgical history, cyclical pain, and a mass at the surgical scar. Magnetic resonance imaging (MRI) is the imaging of choice owing to its high sensitivity and specificity when diagnosing scar endometriosis. CASE REPORT: We report a 35-year-old woman who presented to the Obstetrics and Gynecology (OB/GYN) clinic with a triad of positive surgical history (cesarean section), cyclical abdominal pain, and an abdominal mass. Physical examination revealed a protruding, hyperpigmented mass at the left corner of the Pfannenstiel incision. An MRI was done, which showed a 3×3×3.5 cm left lower abdominal wall soft-tissue mass. A clinical diagnosis of scar endometriosis was made based on suggestive history, physical examination, and imaging. The mass was surgically removed and the patient made a full recovery. CONCLUSIONS: Cesarean scar endometriosis is a complication of cesarean sections and should be a differential diagnosis when considering female patients with an abdominal mass and cyclical pain following an abdominal surgical procedure. A clinical diagnosis is made on the basis of thorough history-taking, physical examination, and imaging (particularly MRI). The criterion standard treatment is surgical excision.