Skin Endometriosis at the Caesarean Section Scar: A Case Report and Review of the Literature

Cutaneous endometriosis is one of the rare gynecological conditions. Endometriosis is defined as the presence of endometrial glands and stroma outside the endometrial cavity. It commonly occurs in pelvic sites, such as the ovaries, cul-de-sac, bowel, or pelvic peritoneum. Endometriosis at the incisional scar is difficult to diagnose because of nonspecific symptoms. Usually, patients complain of pain at the site of the incision during menstruation. The main causes in most of the reported cases are obstetrical and gynecological surgeries. Endometrial tissues may be directly implanted in the scar during operation and, under hormonal stimulation, proliferate and form scar endometriosis. Diagnosis is usually made following histopathology. A wide excision is recommended to prevent recurrence. We report a case of a 33-year-old woman presenting with a brownish mass on the lateral aspect of the Pfannenstiel incision from a previous cesarean section scar. The symptoms appeared two years after her operation. The patient had cyclical pain and brownish discharge from the lesion during menstruation. Excision of the skin lesion with underlying subcutaneous tissue showed multiple, minute, firm hemorrhagic foci. Histopathology was performed and revealed a benign endometrial gland and stroma in the tissues, confirming the diagnosis of scar endometriosis. Cutaneous endometriosis is an uncommon gynecological condition and difficult to diagnose because of the nonspecific symptoms. Usually, it is confused with other dermatological and surgical diseases and delays the diagnosis and management. Surgical scar endometriosis following obstetric and gynecological procedures is more frequent recently due to an increase in the number of caesarian sections worldwide. Health care providers should suspect cutaneous endometriosis in any women with pain and a lump in the incisional scar after pelvic surgery.