caesarian scar

A 28-year-old female presented with dull aching pain in lower abdomen (on & off), swelling over previous caesarean scar site and irregular menstrual cycles over preceding 3 months. She had a history of 2 caesarean sections between 2014-2016. Medical history included Pulmonary Kochs, treated in 2014. Patient’s body mass index was 22 kg/m2. Local examination revealed a 6 x 7 cm tender, firm, ballot able mass over the left lateral aspect of pfannensteil scar line, arising from anterior abdominal wall. A local ultrasound reported a well defined heterogeneously hyperechoic lobulated lesion measuring 6.3 x 4.4 x 7cm in the left rectus muscle underlying the LSCS scar site with multiple cystic areas in the periphery of the lesion with central echogenic areas and mild vascularity suggesting of scar endometriosis. Fine needle aspiration cytology revealed endometrial lining cells. All routine blood investigations were within normal limits. Wide en-bloc excision of the abdominal wall lump with bilateral tubal ligation was done under spinal anaesthesia. 7 x 5 x 3 cm mass involving the subcutaneous tissue, rectus muscle, rectus sheath and peritoneum was excised. Omentum was adherent to the mass and to anterior uterine surface. Adhesiolysis was done. Mini abdominoplasty performed and rectus sheath reconstructed with non-absorbable Ethilon no. 1 using continuous interlocking sutures. Post-operative period was uneventful and patient treated with intravenous antibiotics, abdominal binder, stool softeners, cough suppressants and injection Leuprolide. Histopathology showed fibro-adipose tissues with interspersed glands and stroma of endometriosis which confirmed the diagnosis. Follow up period of 3 months was uneventful.