Mogadishu doctors diagnose rare C-section scar endometriosis in Somali patient

Mogadishu — A rare cesarean section complication has been confirmed in Somalia after a 30-year-old woman developed scar endometriosis, a painful condition in which endometrial tissue grows in a surgical incision, according to a new case report by Dr. Abdirahman Omar Moallim of Kaafi Hospital and Dr. Mohamed Ali Kahiye of Sahan Diagnostic Center.

The case underscores an emerging risk in Somalia’s maternal health system as cesarean deliveries rise, especially in urban centers. Scar endometriosis is often mistaken for a hernia or postoperative infection and remains underdiagnosed in low-resource settings. Global research estimates its incidence at 0.03% to 1.7% following cesarean delivery, but the true burden is believed to be higher where imaging and pathology services are limited.

The patient presented with more than a year of cyclical pain at the site of a prior Pfannenstiel (bikini-line) incision and a 4-by-3.5-centimeter tender nodule on the right side of the scar. Her pain intensified during menstruation — a key clinical clue that endometrial tissue outside the uterus is responding to monthly hormonal changes.

Ultrasound imaging revealed a hypoechoic, solid mass with limited blood flow, findings consistent with scar endometriosis. Surgeons performed a wide local excision; histopathology confirmed endometrial glands embedded in fibrous tissue. The woman recovered without complications and remained symptom-free at her three-month follow-up.

The authors say early recognition is critical to avoid prolonged suffering and inappropriate treatment. As cesarean section rates increase in Somalia, frontline clinicians are more likely to encounter postoperative nodules and chronic scar pain that could be misattributed to other causes without targeted assessment.

Structural gaps complicate diagnosis and care across the Horn of Africa. The report cites limited access to ultrasound, inconsistent surgical hygiene, and fragmented postoperative follow-up as drivers of missed or delayed diagnoses. Similar cases have been reported in Kenya and Ethiopia, but specialists warn the numbers are likely undercounted because many facilities lack routine pathology services, particularly in rural districts.

Clinicians are urged to maintain a high index of suspicion in women with prior cesarean delivery who report scar-site pain that flares with menstruation. Practical red flags and steps include:

• Cyclic pain localized to a cesarean scar, often with a palpable, tender nodule
• Symptom onset months to years after delivery, sometimes misdiagnosed as hernia or infection
• Ultrasound showing a hypoechoic, solid lesion with variable vascularity; consider further imaging if available
• Definitive management with wide surgical excision and clear margins
• Awareness that hormone-based therapies may offer temporary relief but carry higher recurrence rates

The report calls for strengthened surgical protocols to reduce implanting of endometrial cells during cesarean procedures, improved diagnostic training for general practitioners and midwives, and better referral pathways for imaging and histopathology. Hospitals and clinics — both public and private — are encouraged to adopt standardized follow-up to catch and address postoperative complications earlier.

As Somalia expands access to lifesaving obstetric surgery, specialists say integrating robust infection control, careful tissue handling, and clinician education can help prevent rare but debilitating outcomes like scar endometriosis — and ensure women receive timely, effective care when complications occur.

A nurse at Dayniile Hospital checks the blood pressure of a woman recovering from fistula repair surgery, part of ongoing efforts to expand maternal health services in the capital. © UNFPA/Usame Nur Hussein

By Ali Musa
Axadle Times international–Monitoring.