doiSerbia

Endometriosis in cesarean section surgical scar

Stefanović D. (Institut za bolesti digestivnog sistema Kliničkog centra Srbije, Beograd)
Kerkez M. (Institut za bolesti digestivnog sistema Kliničkog centra Srbije, Beograd)
Đorđević Z. (Institut za bolesti digestivnog sistema Kliničkog centra Srbije, Beograd)
Knežević S. (Institut za bolesti digestivnog sistema Kliničkog centra Srbije, Beograd)
Marković Lj. (Institut za patološku fiziologiju MF, Beograd)
Knežević Đ. (Institut za bolesti digestivnog sistema Kliničkog centra Srbije, Beograd)
Palibrk I. (Institut za bolesti digestivnog sistema Kliničkog centra Srbije, Beograd)
Novaković I. (Institut za humanu genetiku MF, Beograd)
Ignjatović I. (Institut za bolesti digestivnog sistema Kliničkog centra Srbije, Beograd)
Dimitrijević Ivan (Institut za psihijatriju KCS, Beograd)

Introduction: Endometriosis is the presence of endometrial glands and stroma outside of uterine cavity. It may occur in the abdominal wall scar after the operation in which uterus was opened. In cesarean section scar it occurs in 0.4%. It is in 2/3 patients characterized with triad of: tumor, periodic pain associated with menses and history of cesarean section. The mechanism of endometriosis occurring in the cesarean scar is felt to be secondary to iatrogenic transplantation of endometrium or extrauterine decidual tissue into the incision during the cesarean section. Case outline. Forty years old patient with tumor 4,5x4 cm that appeared in abdominal wall scar one year after second cesarean section, followed by periodic pain and macroscopic changes associated with menses. First diagnosis was granuloma in the surgical scar, but as she had periodic symptoms, diferential diagnosis was endometriosis. Hormonal therapy with contraceptive drugs was ordered. As it was no improvement she was operated. The surgical excision of the tumor including fascia and muscle tissue was done. Sample revealed endometrium after histopathologic examination. Patient was completely recovered and without relapse of symptoms during follow up to date. Conclusion. When there is a tumor in the cesarean section scar or scar after the operation in which uterus or ovarial tube was opened, followed with periodical pain and macroscopic changes associated with menses, endometriosis should be considered. Surgical excision of the tumor is sufficient and patohistological examination confirms diagnosis. .

Keywords: endometriosis, cesarean section surgicalscar, tumor