Iatrogenic abdominal wall endometriosis after Strassman's metroplasty in adolescent girl with congenital malformation.

The incidence of scar endometriosis has been estimated to be only 0.03-0.15% of all cases of endometriosis [1, 2].

Case A 14-year-old girl was treated for abdominal scar endometriosis after surgical correction of a congenital malformation. The first admission was in 2020 due to uterine abnormality, complaining of dysmenorrhea since menarche. MRI showed a uterine septum dividing the endometrial cavity asymmetrically with non-communicating hemiuterus due to obstruction by the septum (pic. 1A). Hysteroscopy revealed a small cavity with one uterine ostium. During the laparoscopy, there was a transversally enlarged uterus with an ordinary fundal outline. Robert‘s uterus was confirmed which was an indication for laparotomy and Strassman's metroplasty. The septum between two cavities was excised, followed by hysteroscopy, where there was a single regular-sized uterine cavity connected with two fallopian tubes (pic. 1B). After two years, there were clinical signs of abdominal scar endometriosis confirmed by MRI (pic. 1C), which was removed surgically without compromising the aponeurosis. Histological analysis confirmed the diagnosis of endometriosis nodule secondary to Strassman's metroplasty.

Results The patient was successfully discharged. Dienogest was prescribed for two years. At 3-months follow-up, the patient experienced no pain in the area of the scar.

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