HIDDEN WITHIN THE SCAR: A CASE SERIES OF EPISIOTOMY SCAR ENDOMETRIOSIS

Abstract

Background: Episiotomy scar endometriosis is a rare form of extrapelvic endometriosis resulting from implantation of endometrial tissue into an episiotomy wound during vaginal delivery. Owing to its rarity and nonspecific presentation, diagnosis is frequently delayed or mistaken for other benign perineal conditions. Case Presentation: We report a case series of three women aged 29–35 years who presented 5–6 years after vaginal delivery. All patients complained of cyclical perineal pain associated with a palpable scar swelling that worsened during menstruation. Lesion sizes ranged from 2 × 1 cm to 4 × 3 cm. One patient was initially diagnosed with hidradenoma papilliferum, while another received repeated treatment for presumed recurrent perianal abscess, illustrating the diagnostic challenges associated with this condition. Ultrasonography was normal in one patient, whereas magnetic resonance imaging accurately demonstrated lesion extent in two patients, including deep bulbospongiosus muscle infiltration in one case. All patients underwent complete surgical excision, with perineal muscle reconstruction required in one patient. Histopathological examination confirmed the presence of endometrial glands and stroma in all cases. Postoperative recovery was uneventful, with complete symptom resolution and no recurrence during follow-up. Conclusion: Episiotomy scar endometriosis should be considered in every woman presenting with cyclical perineal pain and a previous history of episiotomy. Careful clinical evaluation, appropriate imaging for assessment of disease extent, complete surgical excision, and histopathological confirmation remain the cornerstone of successful management. This case series highlights the importance of increased clinical awareness to facilitate early diagnosis and avoid unnecessary delays in treatment.