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Scar endometriosis presenting as an acute abdomen: A case report

A 32-year-old Chinese woman with a 1-month history of a slowly growing swelling over the right inguinal region presented with an acute abdomen. The pain over the swelling had increased significantly on the day of admission. However, there was no cyclic fluctuation in size of the swelling. There was an associated fever 2 days before admission. She had a previous low transverse Caesarean section for a term pregnancy 5 years previously. However, there was no history of any chronic abdominal or pelvic pain before the present episode. Her menstrual cycle was regular with no dysfunctional symptoms. At the time of admission the patient was menstruating. Physical examination showed a firm smooth nodule measuring 1.5 × 1.5 cm in the right inguinal region, just below and lateral to the Caesarean scar. The nodule was tender and the overlying skin appeared normal. The provisional diagnosis was an inguinal lymphadenitis. However, the pain worsened over the course of the day of admission and the patient went for an emergency exploration. Intraoperatively, a firm mass measuring 1.5 cm in diameter was found in the subcutaneous tissue and muscular layer. It appeared haemorrhagic and had no clear margins. The mass was excised with part of the external and internal oblique aponeurosis. Histologically, sections of the mass showed numerous glandular structures that were lined with endometrial epithelial cells. The endometrial glands were surrounded by a cellular stroma that resembled the endometrial stroma, with extravasated erythrocytes and some acute inflammatory infiltrates around the glands (Fig. 1). There were intervening muscular fibres, fibrous tissue and subcutaneous fat tissue seen. The histological diagnosis was scar endometriosis in the abdominal wall. The patient recovered uneventfully and was lost to follow-up soon after surgical discharge. Discussion