Endometriosis of incision scar could be a highly troubling issue for a patient. The differential diagnosis of pain or mass at the previous incisional scar after a Cesarean section or other types of surgery could be a combination of the following conditions: hernia or trapped nerve, neuroma, endometriosis, or fibrosis.
What to do?
A skilled gynecological surgeon, who is an endometriosis expert needs to examine you. Your personal history is essential. They should also ask these questions:
- How many days did you stay in the hospital following cesarean section?
- Did your problems pass gas?
- Did you have a postoperative fever?
- Does this mass pop out with period?
- Is it painful?
I would order an MRI of CT scans along with a sonogram of your pelvis alerting the radiologist to an incisional problem. Your overall sutured tissues starting from the uterine incision, bladder fold, and peritoneum, two facial layers of rectus muscle have to be evaluated. The nerve at either side of your bikini incision is the genitofemoral nerve and it often causes numbness around your pubic bone and upper vulva area.
Just last year, we had numerous patients operated on for the same reason. Probably seven or eight (half of them) had endometriosis. The rest had hernias, diffuse fibrosis, and scar tissue.
A patient’s case
“I have had two Cesarean sections, the most recent was ten years ago. My incision has always been sensitive, particularly on the left side. More recently, it has been very painful a couple of days before my period, during, and for a week or so after my period. The sensation is a tearing, restrictive type of pain with swelling”.
“My prior OBGYN who performed the surgery said there were probably just nerve bundles in the incision. I changed to another OBGYN who said it sounded like endometriosis of the incision. She said she has never seen it in her practice and that is relatively rare. She recommended I have an ultrasound. This detected a nodule (This can be felt as well). She determined it was scar tissue, a chronic hematoma, and/or endometriosis. She advised me to consult with a surgeon who basically left the decision up to me if I would like to have the area excised. He said it would be very easy to take care of. It bothers me very much and I would like to have it taken care of. My main concern is that it is done correctly!”
As Dr. Seckin goes over their case, it is clearly endometriosis and that area needs a wide and deep excision. I have to put back fascia properly layer by layer. He would like to view the area underneath from the peritoneal aspect because most likely there is an extension there if it is endometriosis or endometrioma.