Episiotomy Scar Research Articles

Episiotomy Scar Endometriosis — A Rare Presentation

INTRODUCTION: Endometriosis is a benign disorder defined as presence of endometrial glands and stroma outside the normal location. Perineal scar endometriosis, at the episiotomy scar site, is a very rare entity occurring in only about 0.03–0.15%¹ CASE STUDIES: Two cases of episiotomy scar endometriosis in perineum reported in department of obstetrics and gynaecology in Apollo KH hospital at different time period have been discussed in this article. CONCLUSION:Endometriosis is a chronic condition affecting women in reproductive age group. Episiotomy scar endometriosis is a rare entity requiring high clinical suspicion for diagnosis. Treatment of choice for perineal scar endometriosis is surgical excision with wide margins. Early diagnosis and treatment can prevent morbidity

Endocervical adenocarcinoma implantation in episiotomy scar: a case report and review of the literature

BackgroundCervical cancer is a rare malignancy in the 1st months of pregnancy. Implantation of this cancer in an episiotomy scar is a condition that is rarely reported.Case presentationWe reviewed the literature on this condition and reported a 38 year-old Persian patient who had been diagnosed with cervical cancer, clinically stage IB1, 5 months after a term vaginal delivery. She underwent transabdominal radical hysterectomy with ovarian preservation. Two months later she presented with a mass-like lesion in the episiotomy scar which was proved to be of cervical adenocarcinoma origin after biopsy. The patient was scheduled for chemotherapy with interstitial brachytherapy, an alternative to wide local resection, with successful long-term disease-free survival.ConclusionImplantation of adenocarcinoma in an episiotomy scar is a rare occurrence in patients with a history of cervical cancer and previous vaginal delivery near the time of diagnosis which requires extensive local excision as a primary treatment when feasible. The proximity of the lesion to the anus can lead to major complications of extensive surgery. Alternative chemoradiation combined with interstitial brachytherapy can be successful in eliminating cancer recurrence without compromising the functional outcome.

Perineal scar endometriosis

The presence of ectopic endometrial tissue outside the uterine cavity is referred to as endometriosis. It is a harmless condition that is commonly seen in women of reproductive age. It can happen in both the pelvic and extra-pelvic areas. Endometriosis in an episiotomy scar is extremely rare, but due to local infiltration, it can cause significant morbidity in patients. The presence of the classic clinical triad of episiotomy history, tender nodule at the scar site, and cyclical pain can be used to diagnose this condition. Magnetic resonance imaging is a very useful imaging modality for diagnosing and assessing the lesion’s deeper extent.

Episiotomy Scar Endometriosis: A Case Report and Review of Literature.

Abstract
 Background
 Endometriosis is defined as the presence and growth of endometrial tissue implants, outside the uterine cavity. It may be pelvic and extra-pelvic sites. Endometriosis in an episiotomy scar is extremely rare but can lead to significant morbidity in patients due to local infiltration. This condition usually presents with clinical triad of history of episiotomy, tender nodule at the scar site and cyclical pain.
 Case Presentation
 Here we report one such case of episiotomy scar endometriosis in the perineum of a 30 years young female (P1L1) which presented with swelling and pain in perineal region. The clinical examination and Ultrasonography (USG) corroborate with diagnosis of episiotomy scar endometriosis. Excision was done and histopathological examination confirmed the diagnosis.
 Conclusion
 Episiotomy scar endometriosis should always be kept in differential diagnosis when a lady presents with painful perineal swelling which increases during menstruation. This can be diagnosed with clinical and radiological examination. Wide local excision is the treatment of choice. Confirmation of the lesion can be done with histopathological examination.
 Keywords: Episiotomy scar endometriosis, perineal scar endometriosis, scar endometriosis

Magnetic resonance imaging as a diagnostic tool for postpartum fistula-in-ano on episiotomy scar – A case report

The objective of this case presentation is to describe a rare case of fistula-in-ano at an episiotomy site and review the importance of magnetic resonance imaging as a diagnostic tool for the detection of perineal fistulas.

Laparoscopic posterior pelvic exenteration for clear cell adenocarcinoma arising in an episiotomy scar

Malignant degeneration of endometriosis is a very rare event, especially when it develops in an episiotomy scar. A 53-year-old woman with an enlarged perineal mass presented to the hospital. She had undergone vaginal delivery with episiotomy twice. Imaging analyses showed a mass involving the levator ani muscle apart from the rectum, with lymph node metastases to the right inguinal and internal iliac regions. A biopsy specimen of the right inguinal lymph node revealed poorly differentiated adenocarcinoma. She underwent neoadjuvant chemotherapy according to the treatment strategy of anal fistula cancer. Laparoscopic posterior pelvic exenteration and pelvic lymph node dissection with anterior inguinal node dissection was performed, along with perineal reconstruction. Pathological examination revealed clear cell adenocarcinoma with lymph node metastases, derived from extrapelvic endometriosis in the episiotomy scar. She was treated with adjuvant chemotherapy according to the treatment strategy of vulvar cancer, and showed no evidence of recurrence after 15 months of surgery.

Imaging Characteristics of Episiotomy Scars on Translabial Ultrasound: An Observational Study.

Episiotomy has been purported to protect the anal sphincter from injury; efficacy is, however, disputed. Correct execution of episiotomy may have substantial implications. We aimed to describe the characteristics of episiotomy scars on translabial ultrasound (TLUS). In this retrospective observational study involving women after repair of obstetric anal sphincter injuries, 76 women with a history of episiotomy were analyzed. Episiotomy scars were assessed on tomographic ultrasound in the transverse plane using volumes acquired on pelvic floor muscle contraction. We measured scar length, depth, and angle relative to a vertical reference line. Episiotomy scars were described as 1) ipsilateral if they started on the same side as the direction of the episiotomy, 2) contralateral if on the opposite side, and 3) mediolateral if the scar began in the midline. The mean scar angle was 50.5° (SD 14°; range 14.4°-79.3°) while mean scar length was 14.2 mm (SD 4.5; range 5.7-27.5 mm) and depth was 8.4 mm (SD 2.8, range 3.1-18.2 mm). Sixteen (21%) scars were located mediolateral while 32 (42%) were ipsilateral. In 28 (37%) women, the starting point of the episiotomy was located contralateral to the direction of the episiotomy. In this pilot series, the mean angle of episiotomy scars was within the safe zone of 40° to 60°, however, in one-third of cases the cut may have been initially directed toward the sphincter, not away from it. This observation suggests that not all episiotomies are performed optimally.

Management of sexual dysfunction following poorly healed episiotomy in a multipara in low-income setting

Background: Episiotomy describes an incision made on the perineum to widen the vaginal orifice so as to aid delivery of the baby. Though not routinely recommended, it is a common during delivery. Despite the intended positive outcomes, complications like sexual dysfunction, urinary incontinence, chronic pelvic pain, perineal infection do occur following it. When sexual dysfunction occurs as sequelae as a result of poor episiotomy repair technique or poor healing, it can affect sexual intercourse and lead to marital disharmony especially in societies that tend to lean towards patriarchy Case presentation: A 31-year-old Nigerian multiparous lady with three living children presented on account of complaints of lax introitus and lack of sexual satisfaction by the partner. She had poorly healed bilateral episiotomy scar following her last delivery. She has been practicing Kegel’s exercise with no improvement. There was associated threat to their relationship by her partner. Perineolasty and vaginoplasty was done. She had successful recovery and improvement in the quality of sex. Conclusion: This is a rare case of a woman in our clime visiting the clinic to request for perineal reconstruction following complaints by her partner and threat to their relationship. Obstetricians should pay attention to any complaint or worry following episiotomy and offer appropriate care to meet the sexuality needs of the parous following childbirth. Keywords: episiotomy; Kegel’s exercise; perineoplasty; vaginoplasty.

Case report: Treatment of episiotomy scars according to the concept of Fascial Manipulation<sup>®</sup>

Case report: Treatment of episiotomy scars according to the concept of Fascial Manipulation<sup>®</sup>

Providing new insights into the endometriosisassociated cancer arising in episiotomy scars.

Endometriosis-associated malignancy in an episiotomy scar is rare. The predictive factors are poorly understood as are the mechanisms and pathways associated with implantation and malignant transformation. In this study we describe the cases reported in the literature of malignancies arising in endometriosis foci of an episiotomy scar. We identified 5 cases described between 1990 and 2016. These cases represent recurrence of endometriotic lesions in an episiotomy scar after previous diagnosis of endometriosis, 3 to 25 months before. Histology revealed clear cell tumours in 4 cases and a serous papillary carcinoma. The approach encompassed surgical removal for diagnosis and as part of the therapeutic strategy. Adjuvant treatment was performed depending on classical prognostic factors. Mechanisms of endometriosis implantation in scars include the influence of estrogens in the healing process and activation of COX-2, aromatase and matrix metalloproteinases. Nevertheless, for malignant transformation, other pathways seem to play a role, namely inflammation, immune response and oxidative stress, induced by iron deposits due to haemorrhage. Further studies are needed to allow the establishment of a predictive model for malignant transformation of endometriosis in episiotomy scars.

V-Y advancement flap to correct a perineal defect after an episiotomy dehiscence.

Episiotomy scar may be the site of complications and result in wound dehiscence in the long term. The aim of this video article was to describe the surgical steps required to repair a right perineal defect after episiotomy using a V-Y advancement flap. Our patient had an episiotomy dehiscence that had already benefited from an end-to-end repair, but the perineal defect recurred. A V-Y advancement flap was performed. The first step of this surgery was to remove the episiotomy scar. A V-shaped flap was then created to fill the perineal defect. Upon advancement, the V flap was transformed in a Y shape and secured using tension-free absorbable sutures. There was no flap necrosis, and the esthetic result was satisfactory.

Persistent vaginal granulation tissue of a large size on the episiotomy scar

Although persistent granulation tissue continues to be a well-recognized complication of wound healing, the incidence of episiotomy scar granulation tissue is unknown, and reports are rare. Herein, we present a case of multiple hypertrophied and polypoidal granulation tissue of a large size at the site of episiotomy scar treated with surgical excision and the recovery was uneventful with excellent results.

Episiotomy scar as a physiotherapeutic problem - case study

The article presents the case of a 28-year-old woman after vaginal delivery assisted by the use of a vacuum extractor. During delivery, the II° perineal rupture and pelvic floor tissue damage occurred. The patient came to the urogynecological physiotherapy practise because of major pain associated with the episiotomy scar. The article describes effects of physiotherapy.

A rare case of perineal endometriosis in an episiotomy scar

A rare case of perineal endometriosis in an episiotomy scar

Characteristics and long-term outcomes of perineal endometriosis: A retrospective study.

To summarize the clinical features, diagnosis, and treatments of perineal endometriosis (PEM).We retrospectively studied the clinical data of 35 patients with PEM between April 2012 and December 2018 in West China Second Hospital. Patients were divided into the gonadotropins releasing hormone (GnRH) agonist group and non-GnRH agonist group.The main clinical symptom was vulvar painful swellings related to menstrual cycles. Thirty-three patients’ lesions (94.29%) were on the episiotomy scar while 1 case was at the opposite side of the scar. We even found 1 nullipara was diagnosed as PEM. Ten patients (28.57%) were found with anal sphincter involvement. All patients received complete excision of PEM. The recurrence rate of GnRH agonist group was 7.69% (1/13), while the rate of non-GnRH agonist group was 18.75% (3/16).Most PEM was associated with episiotomy history, but PEM could also exist in nullipara. Complete excision of PEM was inevitable. The effect of GnRH agonist on recurrence of PEM needs further studies.

Tumor Handling of Early-stage Cervical Cancer: A Literature Analysis of Villoglandular Adenocarcinoma of the Cervix.

Recent studies have demonstrated the inferior overall survival outcomes of patients with early-stage cervical cancer who undergo minimally invasive surgery (MIS). One possible explanation for these unexpected results is intraoperative tumor manipulation. Considering this hypothesis, we have reviewed the literature on the oncological outcomes of patients with villoglandular adenocarcinoma (VGA) of the cervix, an uncommon variant of cervical cancer that has an excellent prognosis. VGA generally presents as an exophytic mass arising from the endocervix. In a systematic review, we identified 221 patients treated surgically for VGA (FIGO stage Ia-Ib1). Of these, 11 developed recurrence, and four died. The recurrence sites in 8 cases were the pelvis (n=3), vaginal cuff (n=3), episiotomy scar (n=1), and cervix (n=1). Furthermore, 23 VGA-patients were treated by MIS, four experienced recurrence, and one died. Three intraabdominal metastases after MIS were reported. Excessive tumor-handling during MIS or manipulations, e.g. cervix-dilation (during delivery), can worsen the otherwise excellent prognosis.

Ultrasonography and Atypical Sites of Endometriosis.

In the present pictorial we show the ultrasonographic appearances of endometriosis in atypical sites. Scar endometriosis may present as a hypoechoic solid nodule with hyperechoic spots while umbilical endometriosis may appear as solid or partially cystic areas with ill-defined margins. In the case of endometriosis of the rectus muscle, ultrasonography usually demonstrates a heterogeneous hypoechogenic formation with indistinct edges. Inguinal endometriosis is quite variable in its ultrasonographic presentation showing a completely solid mass or a mixed solid and cystic mass. The typical ultrasonographic finding associated with perineal endometriosis is the presence of a solid lesion near to the episiotomy scar. Under ultrasonography, appendiceal endometriosis is characterized by a solid lesion in the wall of the small bowel, usually well defined. Superficial hepatic endometriosis is characterized by a small hypoechoic lesion interrupting the hepatic capsula, usually hyperechoic. Ultrasound endometriosis of the pancreas is characterized by a small hypoechoic lesion while endometriosis of the kidney is characterized by a hyperechoic small nodule. Diaphragmatic endometriosis showed typically small hypoechoic lesions. Only peripheral nerves can be investigated using ultrasound, with a typical solid appearance. In conclusion, ultrasonography seems to have a fundamental role in the majority of endometriosis cases in “atypical” sites, in all the cases where “typical” clinical findings are present.

Comparison of clear cell carcinoma and benign endometriosis in episiotomy scar - two cases report and literature review

BackgroundMalignant endometriosis in an episiotomy scar is rare; only seven cases have been reported previously. Here, we compare two cases of benign endometriosis and clear cell carcinoma.Case presentationThe first case was a 54-year-old woman who presented with a large perineal lesion in her episiotomy scar with high 18F-fluorodeoxyglucose uptake. This location had a history of endometriosis many years ago. She underwent radical excision of the mass and bilateral inguinal lymph node dissection. Histological and immunohistochemical analysis confirmed the presence of clear cell carcinoma arising from endometriosis. Assisted radiotherapy was performed after surgery due to a positive lymph node. No recurrence was detected over a 1-year follow-up period. The second case deals with a 3 × 2 cm mass in the episiotomy scar of a 33-year-old woman. Part of the anal sphincter was resected because of the close proximity of the lesion. Because the disease lay very close to the anus, she received anal sphincter reconstruction combined with mass excision. Pathology result showed typical endometrial glands and interstitial tissues.ConclusionsDeleterious change only happens in patients experiencing perineal endometriosis. Complete excision is crucial for this form of disease; sometimes impairment of the anal sphincter is also necessary. Patients with malignancy required a combination of treatments in order to improve their prognosis.

Infiltrations With Collagen in Episiotomy and Cesarean Scars

Infiltrations With Collagen in Episiotomy and Cesarean Scars

Perianal endometriosis: A rare case report

Perianal endometriosis: A rare case report - ACHR- Print ISSN No: - 2581-5725 Online ISSN No:- 2456-9267 Article DOI No:- 10.18231/2456-9267.2019.0017, IP Archives of Cytology and Histopathology Research-IP Arch Cytol Histopathol Res