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Cited by 12Endometriosis Research and TreatmentGynecological conditions and treatmentsIntestinal and Peritoneal Adhesions

Scar Endometriosis: A Rare Cause of Abdominal Pain

Open access
Nepali, Rohit, Upadhyaya Kafle, Santosh, Pradhan, Tarun, Dhamala, Jiba Nath·2022·Dermatopathology
DOI 10.3390/dermatopathology9020020PMC PMC9149924
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Abstract

Scar endometriosis or incisional endometriosis is the presence of endometrial tissues with glands in the previous incision or scar. Its overall estimated incidence after post-cesarean and post-hysterectomy is 0.03–0.4% and 1.08–2%, respectively. The patient presents with non-specific symptoms such as cyclical abdominal pain at the site of a previous surgical incision and scar and an abdominal lump with a cyclical increment in size, which is tender. The diagnosis is made only after the surgical excision with confirmation by histopathological analysis. We present the case of a 31-year-old female complaining of cyclical abdominal pain and a lump on the right side of a Pfannenstiel incision for five months. She had undergone two Lower Segment Caesarean Sections (LSCSs); the last surgery was eight months prior. Surgical excision was planned with the corresponding clinical features and radiological data. After the surgical excision, the sample was sent for histopathological examination, and scar endometriosis was diagnosed.

AI snapshot

Written from the paper’s full text.

TL;DR

This case report describes a 31-year-old woman with scar endometriosis presenting as cyclical abdominal pain and a tender lump at the right side of a Pfannenstiel incision eight months after her second lower segment cesarean section. Diagnosis was confirmed by histopathology after wide local excision.

Key findings

  • Scar/incisional endometriosis is estimated to occur in 0.03–0.4% after cesarean section and 1.08–2% after hysterectomy, according to the abstract.
  • The patient had cyclical pain beginning 2–3 days before menstruation, peaking during menstruation, and subsiding within three days after menstruation; she required analgesics.
  • Clinical examination found a 3 × 2 cm nodular, tender, ill-defined, slightly fixed, non-mobile lump at the right side of the healed Pfannenstiel scar; intraoperatively the lump was 5 × 3 cm and extended to the anterior surface of the uterus.
  • Wide local excision measured 6 × 4 × 1.4 cm; histopathology showed scattered endometrial glands with stroma, congested/dilated vascular channels, and mixed inflammatory cells, confirming scar endometriosis. The patient was discharged on the fourth postoperative day.

Methods

  • Single case report from Birat Medical College and Teaching Hospital.
  • A 31-year-old female, parity 2 living 1, with two prior lower segment cesarean sections 8 years and 8 months earlier, presented with pain and swelling at a previous Pfannenstiel incision.
  • Evaluation included history, physical examination, ultrasonography, surgical wide local excision, and histopathological examination; the paper also reviews literature on scar endometriosis.

Limitations

  • The paper does not state a limitations section.
  • Evident from the text: this is a single case report, so findings are not generalizable and no comparative or long-term follow-up data are provided beyond discharge on the fourth postoperative day.
  • Evident from the text: diagnosis was confirmed only after surgical excision and histopathology, and imaging modalities are described as helpful for diagnosis and surgical planning but “not diagnostics.”

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3390/dermatopathology9020020

Cites

15 of 15 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 40 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Microscopic examination showed scattered numerous endometrial glands along with stroma.

    “On microscopic examination, multiple sections showed scattered numerous endometrial glands along with stroma (Figure 4, Figure 5 and Figure 6)”
    Quote in the paperSubstantial claim
  • Findingown data

    Intra-operatively, a lump 5 × 3 cm encased in fibrosis tissue extended from the subcuticular plane, infiltrated the rectus sheath, and extended up to the anterior surface of the uterus.

    “Intra-operatively, we found a lump 5 × 3 cm encased in fibrosis tissue extending from the subcuticular plane, infiltrating the rectus sheath, and extending up to the anterior surface of the uterus (Figure 1).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Microscopic examination showed mixed inflammatory cells predominantly comprising mature lymphocytes, histiocytes, and plasma cells embedded against a background of fibro-collageneous, muscular, and adipose stroma.

    “mixed inflammatory cells predominantly comprising mature lymphocytes, histiocytes, and plasma cells embedded against a background of fibro-collageneous, muscular, and adipose stroma”
    Quote in the paperNot a substantial claim
  • Findingown data

    The diagnosis of scar endometriosis was made based on a histopathological report.

    “The diagnosis of scar endometriosis was made based on a histopathological report.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Diagnosis of scar endometriosis is made only after surgical excision with confirmation by histopathological analysis.
  • Findingown data

    Ultrasonography showed an ill-defined heterogeneous heteroechoic focal lesion with mild internal vascularity in the subcutaneous plane of the lower abdominal wall scar.

    “Ultrasonography suggested an ill-defined heterogeneous heteroechoic focal lesion showing the presence of mild internal vascularity in the subcutaneous plane of the lower abdominal wall scar.”
    Quote in the paperSubstantial claim
  • May combine two claims. 11
  • Classified as probably not a substantial claim. 13

  • May combine two claims.

    Findingown data

    The patient had a lump approximately 3 × 2 cm at the right side of the healed Pfannenstiel scar that was nodular, tender, ill-defined, slightly fixed, and non-mobile.

    “A lump approximately 3 × 2 cm at the right side of the healed scar was nodular, tender, ill-defined, slightly fixed, and non-mobile, with no surrounding skin changes or herniation of abdominal content.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The patient was a 31-year-old female with cyclical abdominal pain and a lump on the right side of a Pfannenstiel incision for five months.

    “We present the case of a 31-year-old female complaining of cyclical abdominal pain and a lump on the right side of a Pfannenstiel incision for five months.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    The patient had undergone two Lower Segment Caesarean Sections (LSCSs); the last surgery was eight months prior.

    “She had undergone two Lower Segment Caesarean Sections (LSCSs); the last surgery was eight months prior.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The patient's pain was cyclical, occurring 2-3 days before menstruation, peaking during menstruation, and gradually subsiding within three days after menstruation.

    “The pain was cyclical, occurring 2–3 days before menstruation, peaking during the menstruation, and gradually subsiding within three days after menstruation.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    In this case, symptoms occurred 8 months after the second LSCS surgery.

    “Although the duration for the occurrence of clinical symptoms varies from 3 months to 15 years, in our case, it occurred 8 months after the second LSCS surgery [6].”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Gross examination showed the outer surface was partially cut open and grayish brown to black.

    “On gross examination, the outer surface was partially cut open and grayish brown to black (Figure 2).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The cut surface was a grayish-white to solid brown homogeneous area with focal blackish discoloration.

    “On further cut opening, the cut surface was a grayish-white to solid brown homogeneous area with focal blackish discoloration (Figure 3).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The patient was stable postoperatively and discharged on the fourth postoperative day.

    “Postoperatively, the patient was stable and discharged on the fourth postoperative day.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The estimated incidence of cesarean scar endometriosis is 0.03-0.4%.

    “Cesarean scar endometriosis is the most common abdominal wall endometriosis, with an estimated incidence of 0.03–0.4% [4,5,6,7,8].”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [4] Zhang, 2019, Cesarean scar endometriosis: Presentation of 198 cases and literature review, BMC Womens Health source

      Not checked in the free run.

    • cites [5] Tatar, 2018, Post-Cesarean scar endometriosis, Turkish J. Obstet. Gynecol. source

      Not checked in the free run.

    • cites [6] Tangri, 2016, Scar endometriosis: A series of 3 cases, Med. J. Armed Forces India source

      Not checked in the free run.

    • cites [7] Durand, 2010, Abdominal wall endometriosis, J. Chir. Visc.

      Not checked in the free run.

    • cites [8] Khan, 2017, Risk Factors, Clinical Presentation, and Outcomes for Abdominal Wall Endometriosis, J. Minim. Invasive Gynecol. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    Scar endometriosis is one of the major extra pelvic sites for scar endometriosis, among which a cesarean scar is the most common.

    “Scar endometriosis is one of the major extra pelvic sites for scar endometriosis, among which a cesarean scar is the most common.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Nominato et al. analyzed 72 cases, and 66.6% had lesions in the abdominal wall, and 63.8% were found in the cesarean section in the surgical procedures.

    “Nominato et al. analyzed 72 cases, and 66.6% had lesions in the abdominal wall, and 63.8% were found in the cesarean section in the surgical procedures [2].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] Nominato, 2010, Caesarean section greatly increases risk of scar endometriosis, Eur. J. Obs. Gynecol. Reprod. Biol. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Ultrasonography, CT, and MRI might help establish a diagnosis and facilitate surgical excision but are not diagnostic.

    “Other modalities, such as Ultrasonography, Computed Tomography (CT), and Magnetic Resonance Imaging (MRI), might help establish a diagnosis and facilitate surgical excision but not diagnostics [3,6,7,14].”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [3] Slaiki, 2020, Endometriosis of the rectus abdominis muscles: A rare case of dual location, J. Surg. Case Rep. source

      Not checked in the free run.

    • cites [6] Tangri, 2016, Scar endometriosis: A series of 3 cases, Med. J. Armed Forces India source

      Not checked in the free run.

    • cites [7] Durand, 2010, Abdominal wall endometriosis, J. Chir. Visc.

      Not checked in the free run.

    • cites [14] Bilsel, 2010, Abdominal wall endometrioma; A 10-year experience and brief review of the literature, J. Surg. Res. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The duration for the occurrence of clinical symptoms of scar endometriosis varies from 3 months to 15 years.

    “Although the duration for the occurrence of clinical symptoms varies from 3 months to 15 years, in our case, it occurred 8 months after the second LSCS surgery [6].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] Tangri, 2016, Scar endometriosis: A series of 3 cases, Med. J. Armed Forces India source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Medical therapy such as Gn-RH agonist, Progesterone, oral contraceptive pills, and danazol have been tried, but they only allow partial relief and cause recurrence quickly.

    “Medical therapy such as Gn-RH agonist, Progesterone, oral contraceptive pills, and danazol have been tried, but they only allow partial relief and cause recurrence quickly [3,6,15].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [3] Slaiki, 2020, Endometriosis of the rectus abdominis muscles: A rare case of dual location, J. Surg. Case Rep. source

      Not checked in the free run.

    • cites [6] Tangri, 2016, Scar endometriosis: A series of 3 cases, Med. J. Armed Forces India source

      Not checked in the free run.

    • cites [15] 2015, Surgical Treatment of Scar Endometriosis Following Cesarean Section, a Series of 12 Cases, Indian J. Surg. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Cesarean scar endometriosis is the most common abdominal wall endometriosis.

    “Cesarean scar endometriosis is the most common abdominal wall endometriosis, with an estimated incidence of 0.03–0.4% [4,5,6,7,8].”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [4] Zhang, 2019, Cesarean scar endometriosis: Presentation of 198 cases and literature review, BMC Womens Health source

      Not checked in the free run.

    • cites [5] Tatar, 2018, Post-Cesarean scar endometriosis, Turkish J. Obstet. Gynecol. source

      Not checked in the free run.

    • cites [6] Tangri, 2016, Scar endometriosis: A series of 3 cases, Med. J. Armed Forces India source

      Not checked in the free run.

    • cites [7] Durand, 2010, Abdominal wall endometriosis, J. Chir. Visc.

      Not checked in the free run.

    • cites [8] Khan, 2017, Risk Factors, Clinical Presentation, and Outcomes for Abdominal Wall Endometriosis, J. Minim. Invasive Gynecol. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Laxmi et al. found a sharply rising trend of LSCS rates from 20 to 81% in different private hospitals in Nepal.

    “Laxmi et al. analyzed the growth rate of LSCS and found a sharply rising trend of LSCS rates from 20 to 81% in different private hospitals in Nepal, suggesting over-medicalization in childbirth and obstetric care [13].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [13] Laxmi, 2017, Rising Cesarean Section Rates in Nepal: Question of safety and Integrity on Obstetric Emergency Practice, J. Gynecol. Womens Health

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Surrounding primitive pluripotent mesenchymal cells may undergo specialized metaplasia to form cesarean scar endometriosis.

    “Additionally, the surrounding primitive pluripotent mesenchymal cells may undergo specialized metaplasia to form cesarean scar endometriosis [7,8].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [7] Durand, 2010, Abdominal wall endometriosis, J. Chir. Visc.

      Not checked in the free run.

    • cites [8] Khan, 2017, Risk Factors, Clinical Presentation, and Outcomes for Abdominal Wall Endometriosis, J. Minim. Invasive Gynecol. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Malignant transformation has been found in scar endometriosis, among which endometrioid carcinoma is the most common.

    “Malignant transformation has also been found, among which endometrioid carcinoma is the most common one [14].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] Bilsel, 2010, Abdominal wall endometrioma; A 10-year experience and brief review of the literature, J. Surg. Res. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Fine-Needle Aspiration Cytology (FNAC) is an essential diagnostic tool that can help establish a diagnosis and eliminate malignancy.

    “Fine-Needle Aspiration Cytology (FNAC) is an essential diagnostic tool that can help in establishing a diagnosis and eliminating the malignancy [14].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] Bilsel, 2010, Abdominal wall endometrioma; A 10-year experience and brief review of the literature, J. Surg. Res. source

      Not checked in the free run.

19 of 19

  • The paper relies on this without support.

    Cyclical abdominal pain and a tender abdominal lump at the site of a previous surgical scar are symptoms of scar endometriosis.

    “The patient presents with non-specific symptoms such as cyclical abdominal pain at the site of a previous surgical incision and scar and an abdominal lump with a cyclical increment in size, which is tender.”
    “The common symptoms include cyclical pain, swelling worsening during the menstrual cycle, and rarely bleeding in the lesion area; however, there may be non-cyclical symptoms.”

  • The paper relies on this without support.

    Diagnosis of scar endometriosis is made only after surgical excision with confirmation by histopathological analysis.

    “The diagnosis is made only after the surgical excision with confirmation by histopathological analysis.”
    “The diagnosis is confirmed by the histopathological examination of the excised tissue.”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Cesarean scar endometriosis is the most common type of abdominal wall endometriosis.

    “Cesarean scar endometriosis is the most common abdominal wall endometriosis, with an estimated incidence of 0.03-0.4% [5].”

    From Abdominal Wall Endometriosis at the Cesarean Section Scar (2023) · cites this paper as [5]

  • The estimated incidence of cesarean scar endometriosis is 0.03-0.4%.

    “Cesarean scar endometriosis is the most common abdominal wall endometriosis, with an estimated incidence of 0.03-0.4% [5].”

    From Abdominal Wall Endometriosis at the Cesarean Section Scar (2023) · cites this paper as [5]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Symptom onset is reported as both three and eight months after surgery

    Minor

    The abstract says the patient had symptoms for five months and that her last cesarean section was eight months earlier, placing symptom onset about three months after surgery. The discussion instead says symptoms occurred eight months after that surgery.

1 of 1

Cites

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2 of the 17 references couldn’t be matched to a known paper.

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Related

Authors
Nepali, R., Upadhyaya Kafle, S., Pradhan, T., & Dhamala, J. N.
Affiliations
  • Department of Obstetrics and Gynaecology, Birat Medical College and Teaching Hospital, Buddhiganga-02, Morang, Biratnagar 56617, Nepal
  • Department of Pathology, Birat Medical College and Teaching Hospital, Buddhiganga-02, Morang, Biratnagar 56617, Nepal
Corresponding author
Dhamala, Jiba Nath
ORCID
Venue
Dermatopathology
Publisher
MDPI AG
Published
2022-05-05
Volume
9
Issue
2
Pages
158-163
ISSN
2296-3529 (ISSN-L)
DOI
10.3390/dermatopathology9020020
PMC
PMC9149924
OpenAlex
W4229014198
Semantic Scholar
76b6eaed4eddb4ca704b7f100324e79e3efed243
Cited by
12
References
17
Citations by year
2026: 2 · 2025: 5 · 2024: 1 · 2023: 3 · 2022: 1
FWCI
2.11
Type
journal article
Language
en
Open access
Licence
Locations
  • Dermatopathology (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
  • Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
  • Health Sciences › Medicine › Surgery › Intestinal and Peritoneal Adhesions
Keywords
scar endometriosis, Pfannenstiel incision, cesarean section, surgical excision, histopathological diagnosis

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