Cesarean Scar Endometriosis Diagnosis and Care (CSE-DxCare): A Clinical Framework for Post-Cesarean Scar Endometriosis Based on a Case Report Evaluation

Abstract

Background: Scar endometriosis is a rare manifestation of endometriosis, occurring in less than 1% of cases, typically following obstetric or gynecologic surgeries such as cesarean section. It presents a diagnostic challenge due to its non-specific symptoms, commonly mimicking other abdominal wall pathologies. Aim and Objectives: 1. To analyse and review the clinical presentation and treatment of a patient with cesarean scar endometriosis. 2. To evaluate differential diagnoses and provide effective symptom relief and definitive management. Materials and Methods: A retrospective case report of a 30-year-old female who presented with chronic lower abdominal pain to the General Surgery outpatient department. Clinical evaluation, imaging (USG and MRI), diagnostic laparoscopy, and histopathological analysis were performed. Case Summary: The patient reported progressive, cyclical pain over a previous cesarean scar for six months, aggravated during menstruation. MRI revealed a heterogeneous lesion (34×12 mm) within the anterior abdominal wall. Diagnostic laparoscopy confirmed a 5×3 cm mass invading the rectus sheath. Wide local excision was performed, and histopathology confirmed endometriosis with granulation tissue. Results: Postoperative recovery was uneventful. Abdominal wall reconstruction with mesh was done. The patient was administered an injection of Leuprolide 3.75 mg monthly for three months. No recurrence was noted in the short-term follow-up. Conclusion: Scar endometriosis should be considered in women presenting with cyclical abdominal pain and a history of uterine surgery. Surgical excision remains the gold standard treatment, and histopathological confirmation is essential. Hormonal therapy can aid in symptom control and recurrence prevention. Long-term follow-up is recommended.