Presentation
Right lower abdominal wall region pain. Lower segment caesarean section two years prior.
Patient Data
Right lower anterior abdominal wall nodule close to the LSCS scar; measuring 17 x 14 x 10 mm. Located in the deeper the subcutaneous fat and abutting the anterior rectus sheath without extension in the right rectus abdominis muscle. Irregularly shaped hypoechoic lesion with cystic spaces without calcification. Few peripheral internal flow signals.
Retroverted uterus measuring 77 (length) x 42 (width) x 32 (anteroposterior) mm. Normal myometrium. The combined thickness of the proliferative phase endometrium is 9 mm. No endometrial lesion or collection. Normal cervix and both ovaries. No adnexal mass lesion.
As compared to the previous scan, the right lower anterior abdominal wall nodule has increased in size measuring 29 (craniocaudal) x 28 (width) x 23 (anteroposterior) mm. Now it has become predominantly cystic with multiple small cysts with fluid echo levels. It appears like an ovary sitting in the subcutaneous plane with multiple haemorrhagic follicles/endometriotic cysts.
No other interval change.
Excision specimen photo. There was no invasion of the underlying right rectus abdominis muscle during surgery.
Case Discussion
The case shows an interval change in caesarian scar endometriosis. Histopathology was suggestive of scar endometriosis.
Gross specimen photo courtesy of operating surgeon Dr. Drashti Patel.
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