Author(s): Obaro J., Cox A., East K.B.
Abstract: Scar endometrioma is believed to be due to direct implantation of endometrial cells during surgical intervention, which are later activated by oestrogen. This occurrence has been noted with various incisions where endometrial tissues may have been disrupted, including episiotomy, laparoscopy and caesarean section. It is an iatrogenic complication which can be avoided. A large Swedish prospective cohort study reported that the risk of developing symptomatic endometriosis was doubled in women who had at least one Caesarean in a 10 year's period; Caesarean scar endometriomas contributed to 9% of these. Whilst there is dearth of publication on implications of caesarean section on future pregnancy, there is a lack of focus on non-obstetric long term complications and implications on women's health. Scar endometrioma is one of the complications which can be minimised by paying attention to surgical technique. The Caesar Trial did not show any benefit in non-closure of peritoneum or single layer closure apart from saving few minutes of operating time and hence advised caution until long term outcomes are reported. We would like to present two significant cases of scar endometrioma in women with no previous diagnosis of endometriosis, to generate awareness of this iatrogenic complication, to focus on potential pitfalls in current surgical practise and suggest changes in technique to avoid iatrogenic inoculation of endometrial tissue into the abdominal wall. There is a strong need for a new clinical guidance on caesarean section technique with emphasis on restoring anatomy to prevent long term complications and morbidity associated with endometriosis.
Publication Type: Journal: Conference Abstract