Endometriosis: a painful and a deeply infiltrative disease invading the urinary bladder, uterus and the abdominal wall: A case report

Introduction: Urological endometriosis is rare and accounts for approximately 1% of women with endometriosis. The pathophysiology of bladder endometriosis may be divided into two different causes, namely primary and secondary. The primary form occurs spontaneously and manifests in a form of a generalized pelvic disease whereas the secondary form is thought to be iatrogenic and typically occurs after pelvic surgery such as Cesarean section or hysterectomy Case presentation: A middle-aged woman with complaints of cyclical episodes of lower abdominal pain associated with menstrual periods over 8 months. The complaints started after one month post lower segment caesarean section. The patient was further evaluated using MRI of the abdomen and pelvis which revealed endometriotic scar extending from the abdominal wall as a linear tract and then extending towards the uterus and also involving the dome of the bladder. The patient then underwent diagnostic Hysteroscopy with Dilatation and curettage along with Diagnostic Cystoscopy with transurethral resection biopsy of the mass. Histopathological examination revealed evidence of endometriosis. Patient underwent Exploratory Laparotomy with Hysterectomy with Bilateral Salpingectomy with partial cystectomy with abdominal wall resection to remove the entire endometriotic tissue along with Abdominal wall reconstruction using Prolene mesh for abdominal wall closure. Postoperative course involved a wound gape without infection of the underlying mesh which was managed with regular dressing followed by secondary suturing of the wound. Patient has been on regular follow up for the last one year with no recurrence of complaints. Conclusion: Bladder endometriosis can often mimic pelvic malignancy resulting in radical surgeries. They can be a rare complication of a previous Cesarean section. More data is needed to determine the relationship of Cesarean scar niche in bladder endometriosis.