Relief of Pain in Scar Endometriosis - Medical Vs Surgical Treatment

Background: Scar endometriosis is a rare form of extra pelvic endometriosis characterized by the ectopic implantation of endometrial tissue in surgical scars, typically following obstetric or gynaecological procedures such as caesarean section or hysterectomy. This tissue remains hormonally responsive, leading to cyclical pain, swelling, or bleeding at the scar site. The most widely accepted pathogenesis is iatrogenic transplantation during surgery. Endometriosis affects 5?10% of women of reproductive age worldwide and is often associated with chronic pain and infertility. Scar endometriosis, though uncommon and difficult to diagnose, may clinically mimic conditions such as hernia, lipoma, or hematoma. Common symptoms include a palpable mass and cyclical pain at the scar site. Other sites of extrapelvic endometriosis include the bladder, bowel, omentum, lungs, umbilicus, and abdominal wall. Results: The mean age of the patients was 32.41 ? 4.71 years, with an age range of 25 to 39 years. The most common presenting symptoms were a palpable mass and cyclical abdominal pain. All 12 cases were confirmed as scar endometriosis through histopathological examination. Among the participants, 58.3% underwent surgical excision of the lesion, while 41.7% received medical therapy with various hormonal agents. Post-treatment analysis revealed a significant reduction in pain scores, with the mean VAS score decreasing from 7.42 ? 1.08 to 3.00 ? 0.85 (p = 0.000). However, no statistically significant difference in pain reduction was found between the surgical and medical treatment groups (p = 0.613). The average duration of hospital stay was 2.53 ? 1.2 days. Additionally, there was no significant correlation between the size of the lesion and either patient age or the number of previous cesarean sections. Conclusion: Scar endometriosis, though uncommon, is a notable cause of chronic cyclical abdominal pain in women with a history of pelvic or abdominal surgeries. In this study, the most frequently observed clinical features included a palpable abdominal mass, cyclical pain, and dysmenorrhea. All cases were confirmed by histopathological examination, highlighting the critical role of tissue diagnosis in establishing a definitive diagnosis and guiding appropriate management. Both surgical and medical treatments proved effective in alleviating pain, with a statistically significant reduction in mean VAS pain scores observed following intervention.