Differential Diagnosis for Incisional Endometriosis
Single Most Likely Diagnosis
- Endometriosis: This is the most likely diagnosis given the presentation of incisional endometriosis, which occurs when endometrial tissue grows in a surgical scar, often after a cesarean section or other pelvic surgery. The symptoms and history typically point towards this condition.
Other Likely Diagnoses
- Suture granuloma: A benign condition that can occur at the site of surgical scars, caused by a reaction to the suture material. It can mimic the symptoms of incisional endometriosis, such as a palpable mass and pain.
- Hernia (e.g., spigelian or incisional hernia): A hernia occurring through a previous surgical incision can present with similar symptoms, including a bulge and discomfort.
- Abscess or infected seroma: An infection or collection of fluid at the surgical site can cause pain, swelling, and a palpable mass, similar to incisional endometriosis.
Do Not Miss Diagnoses
- Malignancy (e.g., sarcoma, carcinoma): Although rare, the possibility of a malignant tumor at the site of a previous surgical scar cannot be overlooked. A thorough evaluation is necessary to rule out cancer.
- Desmoid tumor: A rare, benign but locally aggressive tumor that can occur in surgical scars. It can cause significant morbidity if not diagnosed and treated properly.
Rare Diagnoses
- Dermoid cyst: A benign cystic teratoma that can occur in the skin, including in surgical scars. It is a rare consideration but should be kept in mind for unusual presentations.
- Foreign body reaction: A reaction to a retained foreign body, such as a surgical sponge or instrument, can cause a mass and symptoms similar to incisional endometriosis, although this is exceedingly rare.
- Lymphoma or other lymphoproliferative disorders: Extremely rare, but these conditions can present with masses or lesions in unusual locations, including surgical scars.