April 2018 · Volume 7 · Issue 4 Page 1641 International Journal of Reproduction, Contraception, Obstetrics and Gynecology Mangla M et al. Int J Reprod Contracept Obstet Gynecol. 2018 Apr;7(4):1641-1644 www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789 Case Report Scar endometriosis: not a rarity now a day Mishu Mangla, Ruchira Nautiyal, Deepmala Deepmala, Jashan Chhatwal* INTRODUCTION Endometriosis is defined as the presence of functioning endometrial tissue, including both glands and stroma, outside of the uterine cavity. It is most commonly found in the pelvic cavity with ovaries, posterior cul-de-sac, pelvic ligaments, bowel and recto vaginal septum being the most common sites. Unusual sites include thorax, nervous system, urinary tract and even the skin. 1 Endometriosis of the subcutaneous tissue and scar is very rare with an incidence reported to be 0.03 - 0.4% of all women undergoing caesarean sections. 2 Although scar endometriosis has been most commonly reported after caesarean sections, other gynecologic surgeries like myomectomy, hysterectomy, hysterotomy, tubal surgeries, appendectomy, amniocentesis, or episiotomy have also been reported to be followed by scar endometriosis. 3 Here author discuss a case of scar endometriosis developing in the scar of previous caesarean section, 5 years after the primary surgery. CASE REPORT A 31 years old female came to Gynecology outpatient department with the complaint of mass just below the site of old caesarean section scar, from last 3 years. She gave a history that the mass was slowly and progressively increasing in size from last 3 years, painful and discharged greenish colored fluid at the time of menstruation. Her past history was significant as she had undergone 3 caesarean sections, last caesarean 5 years ago. Examination revealed a 6 × 6 cm hyper-pigmented mass with 4-5 punctate spots on it (Figure 1). The lesion was about 2 cm below the left margin of the caesarean scar. It was firm in consistency, fixed to the underlying sub cutaneous tissue, tender and on pressing discharged reddish green colored fluid. There was no local or regional lymph node enlargement. An MRI was done which showed a 6 × 6 × 6 cm intensely enhancing area in anterior abdominal wall on left side of midline extending up to subcutaneous tissue (Figure 2). ABSTRACT Endometriosis at the site of previous surgery scar is much on the rise now-a-days mainly due to increased rate of caesarean sections. Generally, it presents as a triad of underlying mass at the incision site, cyclical menstrual scar pain with or without discharge from scar site, and history of previous gynecological or obstetric surgery leads to the preoperative diagnosis. In rare cases, the clinical presentation is atypical, and diagnosis is mad after surgical excision. Here we discuss a case of scar endometriosis that presented to us with complaint of greenish coloured discharge from a lesion below the primary scar site 5 years after the primary surgery. Through this article, authors wish to discuss the etiology, management and preventive measures for scar endometriosis. Keywords: Endometriosis, Previous cesarean, Scar Department of Obstetrics and Gynaecology, Swami Rama Himalayan University, Dehradun, Uttarakhand, India Received: 05 February 2018 Accepted: 07 March 2018 *Correspondence: Dr. Jashan Chhatwal, E-mail: dr.jashanchhatwal@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20181371