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Scar endometriosis

Scar endometriosis is a term given to endometriosis occurring in a Caesarian section scar. It can be located at the skin, subcutaneous tissue, rectus muscle/sheath, intraperitoneally, or in the uterine myometrium (within uterine scar).

Epidemiology

The reported incidence of abdominal scar endometriosis following Cesarean section the incidence is 0.03 - 0.6% 1,6.

Clinical presentation

Most patients have cyclical pain (upto 70% 5). The pain is usually intermittent and associated with the patient's menstrual cycle but it may be constant in nature. The overlying skin may be hyperpigmented due to deposition of haemosiderin. Some patients may be asymptomatic 4.

Pathology

It is thought to be caused by implantation of endometrial stem cells at the surgical site at the time of uterine surgery.

Radiographic features

For general imaging features of endometriosis - refer to the parent article.

Ultrasound

Sonographic features are not specific. A subcutaneous nodule having relatively irregular borders, a heterogeneous echotexture with internal scattered hyperechoic echoes surrounded by a hyperechoic ring of variable width, and vascularity may be present 1. Occasionally cystic changes may be present 6.

CT

Well defined soft tissue nodule with heterogenous post-contrast enhancement and streakiness in the surrounding tissue.

MRI

Is the most sensitive imaging modality. Often accurately locates the lesion in relation to a previous C section scar, with signal characteristics similar to that of background endometriosis.

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