Risk Factors, Clinical Presentation, and Outcomes for Abdominal Wall Endometriosis
Abstract
Study objective To evaluate the risk factors, presentation, and outcomes in cases of abdominal wall endometriosis.Design A case-control study (Canadian Task Force classification II-2).Setting An academic medical center.Patients A total of 102 (34 cases and 68 controls) were included.Interventions Surgical resection of abdominal wall endometriosis.Measurements and main results Cases underwent surgical excision for abdominal wall endometriosis at Mayo Clinic from January 1, 2000, through December 31, 2013. For each case, 2 controls were randomly selected from a list of women who had surgery in the same year with minimal (American Society for Reproductive Medicine stage I-II) endometriosis. A chart review was completed for variables of interest. Regression models were used to identify independent risk factors associated with abdominal wall endometriosis.Results In 14 years, 2539 women had surgery for endometriosis at Mayo Clinic. Of these, only 34 (1.34%) had abdominal wall endometriosis. The mean age was 35.2 ± 5.9 years, and the median parity was 2 (range, 0-5). Clinical examination diagnosed abdominal wall endometriosis in 41% of cases, with the cesarean delivery scar being the most common site (59%). There was a strong correlation between the size of the lesion on clinical examination compared with the size of the pathology specimen (r 2 = 0.74, p < .001). When compared with controls, cases had significantly higher parity and body mass index, more cyclic localized abdominal pain, less dysmenorrhea, longer duration from the start of symptoms to surgery, and more gynecologic surgeries for symptoms without cure. In the final multivariable model, cyclic localized abdominal pain, absence of dysmenorrhea, and previous laparotomy were independently associated with abdominal wall endometriosis with adjusted odds ratios of 10.6 (95% CI 1.85-104.4, p < .001), 12.4 (95% CI 1.64-147.1, p < .001), and 70.1 (95% CI 14.8-597.7, p < .001), respectively, with an area under the curve for the receiver operating characteristic of 0.94 (95% CI, 0.87-0.98). After excision of the disease, repeat surgery was needed in 2 (5.9%) patients with a median time to recurrence of 50.5 (range, 36-65) months.Conclusions Abdominal wall endometriosis is a rare but unique form of endometriosis. Careful history and clinical examination can provide accurate diagnosis and avoid unnecessary delay before surgical intervention. Localized cyclic abdominal pain with the absence of dysmenorrhea and a history of prior laparotomy are independent risk factors with very high accuracy for diagnosis.
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CS is responsible for 57-92% of AWE cases.
“Studies reveal that CS is responsible for 57–92% of AWE cases [3,5,23,26,32,33,34,35,36,37].”
From Surgical Reconstruction of Abdominal Wall Endometriosis Post-Cesarean Section: A Monocentric Experience of a Rare Pathology (2025) · cites this paper as [3]
This finding corroborates the observation of Khan et al. that women presenting with AWE have higher BMIs than controls.
“This finding corroborates the observation of Khan et al. that women presenting with AWE have higher BMIs than controls [19].”
From Abdominal wall endometriosis: An 11-year retrospective observational cohort study (2019) · cites this paper as [19]
The association between previous cesarean section and abdominal wall endometriosis is well described in the literature, since endometrial tissue can be transported to the scar or adjacent tissues during surgery.
“This factor is well described in the literature, since endometrial tissue can be transported to the scar or adjacent tissues during surgery 12,[33][34][35][36][37][38][39][40][41][42][43] .”
From Abdominal Wall Endometriosis: Experience of the General Surgery Service of the Antônio Pedro University Hospital of the Universidade Federal Fluminense (2020) · cites this paper as [34]
The estimated incidence of cesarean scar endometriosis is 0.03-0.4%.
“Cesarean scar endometriosis is the most common abdominal wall endometriosis, with an estimated incidence of 0.03–0.4% [4,5,6,7,8].”
From Scar Endometriosis: A Rare Cause of Abdominal Pain (2022) · cites this paper as [8]
Under proper hormonal influence, the endometrial tissue proliferates and leads to cesarean scar endometriosis.
“Under the proper hormonal influence, the endometrial tissue proliferates and leads to cesarean scar endometriosis [2,4,7,8,9,10,11,12].”
From Scar Endometriosis: A Rare Cause of Abdominal Pain (2022) · cites this paper as [8]
Surrounding primitive pluripotent mesenchymal cells may undergo specialized metaplasia to form cesarean scar endometriosis.
“Additionally, the surrounding primitive pluripotent mesenchymal cells may undergo specialized metaplasia to form cesarean scar endometriosis [7,8].”
From Scar Endometriosis: A Rare Cause of Abdominal Pain (2022) · cites this paper as [8]
Cesarean scar endometriosis is the most common abdominal wall endometriosis.
“Cesarean scar endometriosis is the most common abdominal wall endometriosis, with an estimated incidence of 0.03–0.4% [4,5,6,7,8].”
From Scar Endometriosis: A Rare Cause of Abdominal Pain (2022) · cites this paper as [8]
Abdominal wall endometriosis is associated with cesarean delivery and abdominal hysterectomy.
“One probable exception might be the abdominal wall endometriosis (AWE), which is associated with cesarean delivery and abdominal hysterectomy [102,103].”
From The Pathogenesis of Adenomyosis vis-à-vis Endometriosis (2020) · cites this paper as [102]
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- Authors
- Khan, Z., Zanfagnin, V., El-Nashar, S. A., Famuyide, A. O., Daftary, G. S., & Hopkins, M. R.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Khan, Zaraq
- Venue
- Journal of Minimally Invasive Gynecology
- Publisher
- Elsevier BV
- Published
- 2017-03
- Volume
- 24
- Issue
- 3
- Pages
- 478-484
- ISSN
- 1553-4650 (ISSN-L)
- OpenAlex
- W2573017223
- Semantic Scholar
- 1395669ae9b369b1dec58cba4aee4d96b7e5f824
- Cited by
- 97
- References
- 20
- Citations by year
- 2026: 9 · 2025: 8 · 2024: 12 · 2023: 6 · 2022: 11 · 2021: 11 · 2020: 18 · 2019: 9 · 2018: 7 · 2017: 5
- FWCI
- 12.42
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Minimally Invasive Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
- Health Sciences › Medicine › Obstetrics and Gynecology › Endometrial and Cervical Cancer Treatments
- Keywords
- abdominal wall endometriosis, risk factors, clinical features, dysmenorrhea, previous laparotomy, body mass index, parity, surgical excision, endometriosis diagnosis, clinicopathological correlation, recurrence risk factors, surgical outcomes, endometrioma, endometriosis-associated ovarian cancer
- MeSH terms
- Adult, Cesarean Section, Cicatrix, Endometriosis, Female, Humans, Laparotomy, Postoperative Complications, Reoperation, Risk Factors, Gynecologic Surgical Procedures, Abdominal Pain, Odds Ratio, Case-Control Studies, Abdominal Wall
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