Clinical features of patients with endometriosis on the cesarean scar

Endometriosis is defined as the presence and proliferation of the endometrium outside the uterine cavity, with the pelvis being the most common site. Subcutaneous endometriosis near the cesarean delivery scar is a rare form of extrapelvic endometriosis, occurring in 0.03e1.5% of all women having cesarean deliveries [1]. We retrospectively reviewed the data of five patients with endometriosis on the cesarean scar at the Department of Obstetrics and Gynecology of the Ege University Medical School (Izmir, Turkey) and Buca Government Hospital (Buca, Izmir, Turkey), from 2006 to 2012. Total excision of lesions was performed in all patients. All patients had pathologically confirmed endometriosis in the scar tissue (Fig. 1). The clinical features of the patients are shown in Table 1. Abdominal wall pain and palpable mass especially during menstrual days were the major complaints in all patients. All patients had a history of at least one previous cesarean section and none of them had other abdominopelvic surgeries. The mean diameter of the removed masses was 2.7 cm (range, 2e4 cm). The endometriotic lesions presented 19e46 months (mean, 30 months) after the cesarean procedure. On physical examination, extreme tenderness and semimobile or fixed nodular mass were palpated just above the right/left lateral edge of the Pfannenstiel incision scars. One patient had a bilateral endometriotic lesion. The CA-125 level rose above 35 U/mL in only one patient. Preoperatively, all patients had undergone abdominal ultrasonography. The masses in or around the cesarean scar in these patients appeared hyperechoic and irregular by ultrasonography. Surgical removal was performed with a wide excision providing clear margins in all patients with scar endometriosis (Fig. 2). The endometriotic lesions showed no involvement of the fascia.