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scar endometriosis cesarean section treatment excision
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scar endometriosis cesarean treatment
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PMID: 37380575
I now have comprehensive information from both documents and the medical literature. Here is a full analysis:
Medical Records Analysis - Mrs. Pooja Rani
Patient Summary
| Detail | Value |
|---|---|
| Name | Mrs. Pooja Rani |
| Age/Sex | 35 years / Female |
| UHID | 29787 |
| Date | 01 August 2026 |
| Consultant | Dr. Girish Chatley (MS, Gen. & Laparoscopic Surgeon) |
| BP | 150/99 mmHg (hypertensive) |
| Weight | 68 kg |
| Pulse | 94/min |
Document 1 - OPD Prescription (Image 1)
History & Clinical Findings
- Nodule at the Cesarean section (C/S) scar site - noticed 1 year after C/S done in 2021 (so ~4 years ago now)
- Nodule has increased in size over time
- Painful during menstruation, especially on the 3rd day - this is the classic cyclic pain symptom
- Nodule is tender on examination
- Suspected on clinical and scan assessment
Diagnosis
- Scar Endometriosis (clinically suspected)
Investigations Ordered
| Test | Purpose |
|---|---|
| FNAC | Cytological confirmation of scar nodule |
| CBC | Complete blood count |
| BT/CT | Bleeding time & clotting time (pre-op assessment) |
| INR | Coagulation status |
| KFT | Kidney function |
| LFT | Liver function |
| Viral Panel | Hepatitis B/C, HIV screening |
| Blood Group | Pre-operative typing |
| Urine R/E | Routine urine examination |
The pre-operative blood workup suggests surgical planning is already underway.
Medication Prescribed
- Tab. Zerodol P (Aceclofenac 100 mg + Paracetamol 325 mg) - 1 tab BD x 3 days (for pain relief)
Document 2 - FNAC Report (Image 2)
Lab No.: F-5219/1578 | Date: 01.08.2026
Procedure
- FNAC from suprapubic anterior abdominal wall mass along horizontal C/S scar line
- Done with 21G needle, 10 ml syringe - no local anaesthesia
- Greasy, scanty, particulate material aspirated (one painful pass)
- Swelling size: 1.5 x 1.5 cm, subcutaneous, firm, well-defined
Microscopy Findings
- Cellular cytosmears
- Many loose and tightly packed clusters of hyperchromatic medium-sized endometrial cells and stroma
- Many cystic macrophages and haemosiderin-laden macrophages throughout - a hallmark of old repeated hemorrhage (cyclical bleeding into the lesion)
- Mild haemorrhagic background
- No epithelioid cells, no atypical cells - no malignancy
- No parasitic structures or calcification
Impression
Scar Endometriosis - confirmed cytologically
Pathologist's Note
Excision and histopathological examination strongly recommended for confirmation and definitive treatment
Clinical Interpretation
Scar endometriosis (also called caesarean section scar endometriosis, CSSE) is a well-recognized complication of C/S. Endometrial cells get implanted along the scar during surgery and continue to bleed cyclically with each menstrual cycle, forming a painful nodule. Key features in this case that are textbook-classic:
- Prior C/S (5 years ago, 2021)
- Delayed onset - nodule appeared ~1 year post-C/S
- Cyclic pain - worst during menstruation (3rd day)
- Progressive enlargement
- FNAC showing endometrial cells + haemosiderin-laden macrophages (evidence of repeated hemorrhage)
As per a 2023 review in Clinical Radiology (PMID 37380575), CSSE is an underestimated entity. MRI with T1 fat-saturated sequences (showing hyperintense/haemorrhagic foci) is the most sensitive imaging modality, and surgical excision is the mainstay of treatment.
From Bailey & Love's Short Practice of Surgery, treatment options for endometriosis include:
- Conservative management
- Medical management (simple analgesia, hormonal suppression - progestogens, GnRH agonists, levonorgestrel IUS)
- Surgical management - excision (the definitive treatment for scar endometriosis)
- Bailey and Love's Short Practice of Surgery, 28th Ed.
What Happens Next (Expected Management)
- Pre-operative workup is already ordered (CBC, LFT, KFT, coagulation, viral panel, blood group)
- Excision of the scar nodule with a margin of normal tissue - this is both diagnostic (final histopathology) and curative
- Histopathological confirmation post-excision (the FNAC is cytological/presumptive; histology is gold standard)
- If recurrence risk is a concern or intra-abdominal disease is present, hormonal suppression therapy may be added
The pre-op blood tests and FNAC done same-day strongly suggest the surgical team is planning wide local excision in the near future. The patient should ideally also have a pelvic USG or MRI before surgery to rule out coexisting intra-abdominal or pelvic endometriosis.
Note for Mrs. Pooja Rani or her family: This is not cancer - the FNAC specifically confirmed no atypical or malignant cells. Scar endometriosis is a benign but painful condition that responds very well to surgical removal. Once excised with clear margins, the prognosis is excellent.
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