Cesarean scar endometriosis: presentation of 198 cases and literature review

Ping Zhang,Linna Zhang,Ningling Wang,Chen Zhang,Yeping Yang,Yabing Sun,Hong Xu

doi:10.1186/s12905-019-0711-8

Abstract

BackgroundCesarean scar endometriosis (CSE) is the most common type of abdominal wall endometriosis (AWE). The aim of this study was to systematically identify the clinical features of CSE and recommend precautionary measures.MethodsA large, retrospective study was undertaken with CSE patients treated surgically at our hospital between January 2005 and December 2017.ResultsA total of 198 CSE patients were enrolled, with a mean age of 32.0 ± 4.0 years. The main complaint of the patients was abdominal mass (98.5%), followed by cyclic pain (86.9%). The latency period of CSE was 31.6 ± 23.9 months, and the duration between the onset of symptoms and this surgery was 28.3 ± 25.0 months. A majority (80.8%, n = 160) of the patients had undergone a Pfannenstiel incision, and a minority (19.2%, n = 38) a vertical midline incision. The latency period of CSE in the case of a Pfannenstiel incision was significantly shorter than that in the case of a vertical midline incision (24.0 vs 33.0 months, P = 0.006). A total of 187 (94.4%) patients had a single endometrioma, 11 (5.6%) patients had multiple endometriomas, and the 11 multiple-endometrioma patients had all undergone a Pfannenstiel incision. Lesions of endometrioma were common in corner sites, after either incision: 142/171 (83.0%) in Pfannenstiel incision scars and 32/38 (84.2%) in vertical incision scars.ConclusionsThe findings of this study indicate that the Pfannenstiel incision carries a higher risk of CSE than the vertical midline incision. Thorough cleaning at the conclusion of CS, particularly of both corner sites of the adipose layer and the fascia layer, is strongly recommended for CSE prevention. Further studies might provide additional recommendations.

Highlights

Cesarean scar endometriosis (CSE) is the most common type of abdominal wall endometriosis (AWE)
The presence of ectopic endometrial tissue embedded in the subcutaneous adipose layer and the muscles of the abdominal wall is called abdominal wall endometriosis (AWE)
As the most common type of AWE, CSE is best explained by the iatrogenic direct implantation theory

Summary

Introduction

Cesarean scar endometriosis (CSE) is the most common type of abdominal wall endometriosis (AWE). Endometriosis is a sex hormone-dependent gynecological disease that is characterized by the growth of endometrial tissue outside the uterine cavity [1]. It usually occurs in the pelvis, at sites such as the ovaries and the pelvic peritoneum. With an appropriate supply of nutrients and hormonal stimuli, these endometrial cells survive and proliferate, which leads to CSE. It is an unusual disease, with a reported incidence of 0.03–0.45%, CSE may cause long-term discomfort involving cyclic lower abdominal pain [10, 11]. Case reports of malignant transformation of CSE have been sporadically reported [12,13,14]

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