A rare case of Rectus Sheath Endometriosis

Abstract

Introduction: Scar endometriosis is a rare disease, and is often difficult to diagnose due to nonspecific symptoms, typically involving abdominal wall pain at the incision site at the time of menstruation. Case Report: A 30 year old woman, with previous one caesarean done two years back, presented with complaints of a painful lump over the left lateral aspect of her caesarean scar. On examination, there was a tender fluctuating mass over the left lateral aspect of the scar. Ultrasonography revealed a heteroechoic irregular mass beneath the anterior abdominal wall with vascularity present in the periphery. The patient was posted for Wide Local Excision (WLE). Intra-operatively, the lesion was seen over the rectus sheath. It was excised and sent for histopathological examination, which confirmed the diagnosis of rectus sheath endometriosis. Discussion: Scar endometriomas are believed to be the result of direct inoculation of the abdominal fascia or subcutaneous tissue with endometrial cells during surgical intervention and subsequently stimulated by estrogen to produce endometriomas. Conclusion: Scar endometriosis can be a challenging entity. A post-operative lump at the scar site should be thoroughly evaluated keeping a high index of suspicion.