Patient: What is endometriosis at your incisional scar?
Dr.Seckin: This could be a highly troubling issue for the patient, as you are experiencing. The differential diagnosis of pain or mass at your previous incisional scar after your cesarean section or other type of surgery could be either or combination of following conditions, hernia or trapped nerve, neuroma, or endometriosis or fibrosis.
You need to be examined by skilled gynecological surgeon, who is an endometriosis expert.Your personal history is essential and these questions need to be asked. How many days did you stay in the hospital following cesarean section? Did you problems of passing gas? Did you have postoperative fever? Does this mass pop out with period? Is it painful?
I would order and MRI of CT scans along with sonogram of your pelvis alerting the radiologist to 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 genitofemoral nerve and it often causes numbness at around your pubic bone and upper vulva area.
Just last year, we had numerous patient operated for the same reason , probably 7 or 8, half of them had endometriosis, the rest had hernias, and diffuse fibrosis and scar tissue.
Quoting you, "I have had two c-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 sewn 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 is relatively rare. She recommended I have an ultrasound which detected a nodule (This can be felt as well) and determined it was: scar tissue, a chronic hematoma, and/or endometriosis. I was advised to consult with a surgeon wh o 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! I didn't see any information on your sight regarding endometriosis of the incision, so I was hoping you could give me a little insight and advice!"
As I go over your case here again, it is clearly endo and that area needs a wide and deep excision. Fascia has to be put back properly layer by layer. I would not hesitate to view the area underneath from the peritoneal aspect because most likely there is an extension there if it is endometriosis or endometrioma. I hope this information is helpful to you,