Post-Cesarean Abdominal Wall Endometriosis: A Case Report and Literature Review

Abstract

Background: Abdominal wall endometriosis (AWE) is a rare form of extrapelvic endometriosis, most commonly occurring in surgical scars following cesarean section. Due to its nonspecific presentation, it is frequently misdiagnosed, leading to delayed management. The purpose of our work is to raise clinical awareness about abdominal wall endometriosis and share our experience in managing this condition. Case Presentation: We report the case of a 38-year-old woman, gravida 3 para 3, with a history of three cesarean sections, who presented with a painful parietal mass located at the right angle of her cesarean scar. The pain showed a clear cyclical pattern, worsening during menstruation. Physical examination revealed a firm; tender, erythematous mass measuring approximately 3 cm. Magnetic resonance imaging demonstrated a parietal lesion with a fistulous tract consistent with abdominal wall endometriosis. Initial medical management with a gonadotropin-releasing hormone agonist for three months resulted in partial regression of symptoms and lesion size. The patient subsequently underwent wide surgical excision with clear margins. Histopathological examination confirmed the diagnosis of abdominal wall endometriosis. Postoperative recovery was uneventful, with complete resolution of symptoms and no recurrence during follow-up. Conclusion: Post-cesarean abdominal wall endometriosis should be considered in women presenting with a painful mass at a cesarean scar, particularly when symptoms are cyclical. Diagnosis is quite difficult to establish due to the nonspecific nature of its clinical presentation. Magnetic resonance imaging is valuable for diagnosis and surgical planning. Complete surgical excision remains the definitive treatment, offering excellent outcomes and low recurrence rates. Early recognition is essential to reduce diagnostic delay and improve patient prognosis.