Keywords
Case report
Extrapelvic endometriosis
Rectus abdominis endometriosis
Surgical management
Categories
How to Cite
Abstract
Abdominal wall endometriosis is an uncommon form of extra-pelvic endometriosis that typically develops in association with prior uterine surgery, particularly cesarean delivery. Among its variants, isolated involvement of the rectus abdominis muscle is exceedingly rare and may mimic other postoperative abdominal wall pathologies, resulting in delayed diagnosis.
We report the case of a 28-year-old woman presenting with cyclic pain localized to the right lower abdomen, three years after a cesarean section. Magnetic resonance imaging revealed a 2 × 2 × 1.5 cm lesion within the right rectus abdominis muscle, showing signal characteristics suggestive of endometriosis. The lesion was completely excised through a Pfannenstiel incision with approximately 1 cm of healthy tissue margin, and no mesh reconstruction was required. Histopathological examination confirmed the diagnosis of endometriosis, showing endometrial glands and stroma within skeletal muscle fibers. The postoperative course was uneventful, and the patient remained symptom-free during 12 months of follow-up.
This case emphasizes the need to suspect abdominal wall endometriosis in post-cesarean patients presenting with cyclic pain and a palpable abdominal wall nodule near the surgical scar. Early recognition and complete surgical excision with clear margins are essential to ensure accurate diagnosis and prevent recurrence.
References
1. Zhang P, Sun Y, Zhang C, Yang Y, Zhang L, Wang N, Xu H. Cesarean scar endometriosis: presentation of 198 cases and literature review. BMC Womens Health. 2019: 14 [PMID: 30658623, https://doi.org/10.1186/s12905-019-0711-8]
2. Alnafisah F, Dawa SK, Alalfy S. Skin Endometriosis at the Caesarean Section Scar: A Case Report and Review of the Literature. Cureus. 2018: e2063 [PMID: 29545986, https://doi.org/10.7759/cureus.2063]
3. Nepali R, Upadhyaya Kafle S, Pradhan T, Dhamala JN. Scar Endometriosis: A Rare Cause of Abdominal Pain. Dermatopathology (Basel). 2022: 158 [PMID: 35645231, https://doi.org/10.3390/dermatopathology9020020]
4. Sridhar DL, Reddy K DA, Dhoorjati DB, Phadnis DR. A Rare Case of Scar Edometriosis - Case Report. International Journal of Medical and Biomedical Studies. 2023: 19 https://doi.org/10.32553/ijmbs.v7i1.2654]
5. Horton JD, Dezee KJ, Ahnfeldt EP, Wagner M. Abdominal wall endometriosis: a surgeon's perspective and review of 445 cases. Am J Surg. 2008: 207 [PMID: 18513698, https://doi.org/10.1016/j.amjsurg.2007.07.035]
6. Dorji N, Tshering S, Choden S. Cases of scar endometriosis after caesarean section. Bhutan Health Journal. 2021: 34 https://doi.org/10.47811/bhj.118]
7. Saikia N, Shangpliang DM, Choubey N, Navyasri G. Scar endometriosis-rare sequel of caesarean section: A case report. International Journal of Clinical Obstetrics and Gynaecology. 2021: 210 https://doi.org/10.33545/gynae.2021.v5.i4d.985]
8. Dadhwal V, Sharma A, Khoiwal K, Nakra T. Episiotomy scar endometriosis. Med J Armed Forces India. 2018: 297 [PMID: 30093779, https://doi.org/10.1016/j.mjafi.2017.06.004]
9. Yıldırım D, Tatar C, Doğan O, Hut A, Dönmez T, Akıncı M, Toptaş M, Bayık RN. Post-cesarean scar endometriosis. Journal of Turkish Society of Obstetric and Gynecology. 2018: 33 https://doi.org/10.4274/tjod.90922]
10. Ramdani A, Rais K, Rockson O, Serji B, El Harroudi T. Parietal Mass: Two Case Reports of Rare Cesarean Scar Endometriosis. Cureus. 2020: e6918 [PMID: 32190473, https://doi.org/10.7759/cureus.6918]
11. Goksever Celik H, Karacan T, Kaya C, Uhri M, Savkli AO, Yalcin Bahat P, Altintas T, Usta T, Polat I, Gorgen H, Oral E. Abdominal wall endometriosis: A monocentric continuous series and review of the literature. Journal of Endometriosis and Pelvic Pain Disorders. 2019: 95 https://doi.org/10.1177/2284026519834465]
12. Ferjaoui MA, Arfaoui R, Khedhri S, Abdessamia K, Hannechi MA, Hajjami K, Azri R, Benghalia M, Malek M, Rachdi MR, Neji K. Abdominal wall endometriosis: A challenging iatrogenic disease. Int J Surg Case Rep. 2021: 106507 [PMID: 34656926, https://doi.org/10.1016/j.ijscr.2021.106507]
13. Neamtu R, Dahma G, Mocanu AG, Bernad E, Silaghi CI, Stelea L, Citu C, Dobrescu A, Bratosin F, Grigoras ML, Motoc A, Dema S, Craina M, Chiriac VD, Gluhovschi A. Challenges in Diagnosis and Prevention of Iatrogenic Endometriosis as a Long-Term Surgical Complication after C-Section. Int J Environ Res Public Health. 2022: [PMID: 35270482, https://doi.org/10.3390/ijerph19052791]
14. Matei AM, Draghici-Ionescu AM, Cioplea M, Zurac SA, Boda D, Serban I, Caruntu C, Ilie MA, Fekete GL. Skin endometriosis: A case report and review of the literature. Exp Ther Med. 2021: 532 [PMID: 33815605, https://doi.org/10.3892/etm.2021.9964]
15. Andres MP, Arcoverde FVL, Souza CCC, Fernandes LFC, Abrao MS, Kho RM. Extrapelvic Endometriosis: A Systematic Review. J Minim Invasive Gynecol. 2020: 373 [PMID: 31618674, https://doi.org/10.1016/j.jmig.2019.10.004]
16. Benedetto C, Cacozza D, de Sousa Costa D, Coloma Cruz A, Tessmann Zomer M, Cosma S, Trippia CH, Santos Cavalcanti TC, Alves Castro GR, Kondo W. Abdominal wall endometriosis: Report of 83 cases. Int J Gynaecol Obstet. 2022: 530 [PMID: 35246836, https://doi.org/10.1002/ijgo.14167]
17. Allen SE, Rindos NB, Mansuria S. Abdominal wall endometriosis: an update in diagnosis, perioperative considerations and management. Curr Opin Obstet Gynecol. 2021: 288 [PMID: 34054100, https://doi.org/10.1097/GCO.0000000000000714]
18. Thanasa E, Thanasa A, Kamaretsos E, Kontogeorgis G, Paraoulakis I, Thanasas I. Surgical Treatment of a Rare Case of Extrapelvic Endometriosis in the Rectus Abdominis Muscles With Negative Imaging Findings: A Case Report and Mini Literature Review. Cureus. 2024: e73891 [PMID: 39697966, https://doi.org/10.7759/cureus.73891]
19. Takaya K, Shido H, Yamazaki S. Resection and Abdominal Wall Reconstruction for Cesarean Scar Endometriosis. Case Rep Med. 2022: 7330013 [PMID: 35531576, https://doi.org/10.1155/2022/7330013]
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2025 Arif Onur Atay, Deniz Yilmaz