Presentation
Localized abdominal pain in the left inguinal region. History of a laparotomy for ruptured ectopic pregnancy; also underwent ultrasound in another country which suggested hernia vs. ectopic pregnancy.
Patient Data
A small faintly enhanced soft tissue focal lesion noted at the lower anterior abdominal wall lateral to the left rectus muscle, measures about 19 x 15 x 13 mm, harbors fluid and hyperdense components. No definite connection between the lesion and the peritoneal cavity. No measurable defects could be detected.
Complementary US reveals: a well-defined oval-shaped hypoechoic lesion noted at the left lateral aspect of the scar, harbors minimal fluid around and internal vascularity on color Doppler. No obvious defects could be noticed even on straining.
According to the history of surgical operation, CT and ultrasound findings, a differential diagnosis was made as scar endometriosis vs. desmoid tumor. The differential diagnosis of inguinal hernia was found to be unlikely as no defects could be detected either by CT or ultrasound.
Proven by histopathology as scar endometriosis.
Operative notes:
Under local anesthesia a small incision was done over the left inguinal region at the site of the swelling. The wound is deepened. The swelling appears like endometriosis lesion. It was dissected all around and excised in total.
Histopathology report:
Gross: irregular grey to brown tissue measures about 2.7 x 2.0 x 1.5 cm.
Diagnosis: endometriosis.
Case Discussion
Scar endometriosis is an abnormal presence of endometrial tissue at the site of the scar. Most commonly reported with CS scar. Our case represented an endometriosis at the site of the scar of laparotomy for disturbed ectopic pregnancy. Scar endometriosis should be always considered in any patient who has a history of such operations with localized pain, especially if associated with other features like increased pain during menstruation.
I would like to thank Dr. Pratap Kumar Shinde and Dr. El Sadiq Elmukashfi Ahmed, SQH Surgery Department, for their valuable operative notes.
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