Giant Cesarean Section Scar Endometriosis Presenting with Cyclic Pain: A Neglected Clinical Manifestation—A Case Report

Background: Endometriosis is a chronic gynecological disorder characterized by the presence of endometrium-like tissue outside the uterine cavity. It is most commonly found in the pelvic organs but may also occur in extrapelvic sites, including the intestines, urinary bladder, abdominal wall, thoracic cavity, and other organs. Scar endometriosis is a rare subtype of abdominal wall endometriosis that develops within surgical scar tissue. Giant scar endometriosis is exceptionally uncommon, with lesions rarely exceeding 8 cm in previously reported cases. Case Illustration: A 35-year-old woman, gravida 2 para 2 abortus 0 (P2A0), presented with cyclic pain and bleeding from a previous cesarean section scar during menstruation for the past three years. The pain was described as severe, with an intensity of 7– 8 on the pain scale, significantly interfering with daily activities. The patient also reported a progressively enlarging mass at the surgical scar site. She had a history of cesarean section with sterilization in 2020, and symptoms began two years after the procedure. Physical examination revealed a firm mass that was non-tender, non-erythematous, and showed no signs of inflammation. Ultrasonography demonstrated a hypoechoic lesion in the suprasymphyseal subcutaneous region. Total surgical excision was performed, yielding a large mass measuring approximately 8 × 8× 8 cm adherent to the fascia. Histopathological examination confirmed the diagnosis of scar endometriosis. Conclusion: Giant scar endometriosis is a rare but clinically important condition that should be considered in women presenting with cyclic pain or bleeding at a surgical scar site. Early diagnosis and complete surgical excision are essential to prevent recurrence and improve patients’ quality of life.