A 34-year-old woman who underwent two caesarean deliveries presents with a cyclical painful nodule in the lower abdominal wall scar, enlarging during menses. The BEST next step in management is:

• A GnRH agonist for 6 months as definitive therapy
• B Combined oral contraceptive pills indefinitely
• C Fine needle aspiration cytology followed by antibiotics
• D Wide local excision of the nodule ✓

Explanation

Scar endometriosis following caesarean section presents as a firm, tender, cyclical swelling in the incision. Medical therapy only suppresses symptoms and recurrence is universal on withdrawal, so wide surgical excision with clear margins is the definitive treatment. FNA may be used to exclude malignancy but antibiotics have no role since this is not infective. Recurrence after complete excision is uncommon, unlike pelvic endometriosis.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.