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Endometriosis in a postoperative scar

Andrei Plotski

 Endometriosis in a postoperative scar is a secondary process in scars after surgical procedures affecting endometrium: cesarean section, hysterectomy, amniocentesis

etc. Nevertheless scar endometriosis occurs also after general surgery – appendectomy, cholecystectomy, correction of hernias. The cause of surgical scar endometriosis is believed to be iatrogenic transplantation of endometrium to the surgical wound. Despite the ectopic location, endometrial tissue is able to respond to hormonal effects, thereby causing clinical signs of disease. Endometriosis of postoperative scar is a typical example of extragenital endometriosis. The most common presenting symptom of endometrioma in a scar is a palpable mass associated with cyclic pain and swelling during menses. When the patient complains are not cyclical (25-45% of patients with scar endometriosis) clinical diagnosis is impaired. The typical sonographic pattern of endometriomas is presence of subcutaneous nodule, hypoechoic with hyperechoic strands and irregular margins. Different types of hormonal therapy has been tried with minimal effects. That’s why for endometriosis of postoperative scar total surgical excision is considered to be golden standard for both diagnosis and treatment. In order to prevent scar endometriosis some measures have been proposed. But no measures of prevention have proved its efficiency and all these measures were suggested without any evident scientific corroboration.