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Treating Scar Endometriosis from Cesearean Section

by Rene Frasher, DHSc, PA-C,  JAAPA,  June 7, 2010
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Studies suggest that the prevalence of endometriosis is 0.5% to 5% among fertile women and 25% to 40% among infertile women.2 The most common locations are in the pelvis, involving the ovaries, fallopian tubes, posterior cul-de-sac, uterine ligaments, rectovaginal septum, and surrounding pelvic peritoneum3 (Figure 1). Less common sites include the rectum, inguinal canal, vagina, bladder, kidney, brain, omentum, lymph nodes, lungs, pleura, extremities, umbilicus, and the superficial abdominal wall.1,3 The most common extrapelvic site of endometriosis is a scar resulting from obstetric or gynecologic surgery.1,3,4

Endometriosis in patients with surgical scars is more common in the abdominal skin and subcutaneous tissue than in the muscle and fascia. Endometriosis involving only the rectus muscle and sheath is very rare, and simultaneous occurrence of pelvic endometriosis with scar endometriosis is infrequent. The actual incidence of abdominal wall endometriosis is unknown, but one series reported that only 6% of cases were unrelated to surgical scars.1 In another series, the prevalence of surgically proven endometriosis was 1.6%.1 The most common site was a CS scar, with an incidence of 0.03% to 0.4%.1 Scar endometriosis has been well-documented in incisions where there has been contact with endometrial tissue, including those associated with cesarean delivery, hysterectomy, hysterotomy, episiotomy, ectopic pregnancy, laparoscopy, and tubal ligation. Other cases have been reported in the trocar tract following laparoscopic appendectomy, in the mesh used for umbilical hernia repair secondary to previous laparoscopic myomectomy, and in the needle tract after amniocentesis.1
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