In rare cases, women who have had a cesarean section may end up with endometriosis in their surgical scar tissue, sometimes years after the operation, according to a report.
Endometriosis is a condition in which bits of the lining of the uterus end up in parts of the body they shouldn't be. The misplaced tissue can then wax and wane with a woman's monthly cycle, causing bleeding, irritation and other health problems.
Many general surgeons fail to properly diagnose endometriosis in surgical scars (known as incisional endometriosis), according to a report in the April issue of the Journal of the American College of Surgeons.
Drs. Raminder Nirula and Gregory C. Greaney, from Santa Barbara Cottage Hospital in California, reviewed the cases of 10 general surgery patients who were diagnosed with incisional endometriosis between January 1990 and December 1998. The disease often manifests as a slow-growing, painful lump at the edge of a surgical scar. Two out of 10 women reported that the lump changed characteristics with their menstrual cycle.
The condition was correctly diagnosed in only two cases, the researchers report. Often the lump was initially misdiagnosed as a cyst, incision-related hernia, and in one case, breast cancer that had spread from another part of the body. The women ranged in age from 27 to 41 and experienced symptoms anywhere from 3 months to 10 years. The symptoms began from 1 to 7 years after the cesarean.
With the proper diagnosis, the growths, which were an average of 3 centimeters (or just over 1 inch) in size, were surgically removed. The study is the "largest series in the general surgery literature to date, which underscores our underappreciation of this disease," the authors write.
