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Scar Endometriosis in the Abdominal Wall: a Predictable Condition for Experienced Surgeons
Abstract
PURPOSE: Endometriosis in surgical scars develops in 0.1% of those women who undergo Caesarean section or other obstetric surgery. Herein we analyse and discuss the clinico-pathological characteristics of 15 patients with scar endometriosis in the abdominal wall. METHODS: Fifteen cases of scar endometriosis in the abdominal wall that were treated surgically in our department between 2003 and 2009 were examined retrospectively. Age, parity, complaint, medical or surgical history, pre/postoperative hormonotherapy, size of the mass, surgical procedure, follow-up and disease recurrence were analysed. RESULTS: This retrospective study included 15 patients presenting with 17 postoperative abdominal wall masses. The mean age of the patients was 32.1 +/- 6.0 years (range, 23-48). Eleven of the patients had a painful mass that became bigger before menstruation, two had palpable masses only, and two were hospitalised because of a mass with persistent pain. The locations of the masses were as follows: eight were close to the right side and three were close to the left side; two were in the middle of the Pfanenstiel incision and two were in trocar tracts. The patients' surgical histories included Caesarean section in thirteen, bilateral laparoscopic ovarian cyst excision in one, and laparoscopic appendectomy in one. CONCLUSIONS: If a patient presents with incision pain and a palpable mass after gynaecologic surgery, an incisional endometrioma should be considered. Surgical excision and hormone therapy are effective treatment approaches in these patients.
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In the citing paper
“The treatment of choice for scar endometriosis is wide local excision of the lesion with negative margins, even for recurrent disease.”
From Laparoscopic trocar port site endometriosis: a case report and brief literature review. (2012) · cites this paper as [5]
In the citing paper
“Although useful, CT, USG, and MRI cannot provide a definitive preoperative diagnosis.”
From Laparoscopic trocar port site endometriosis: a case report and brief literature review. (2012) · cites this paper as [5]
In the citing paper
“The CT and MRI characteristics of abdominal wall endometriosis are nonspecific, with both showing a solid enhancing mass in the abdominal wall.”
From Laparoscopic trocar port site endometriosis: a case report and brief literature review. (2012) · cites this paper as [5]
In the citing paper
“The diagnosis of scar endometriosis is usually highly suggestive from the patient's history and examination.”
From Laparoscopic trocar port site endometriosis: a case report and brief literature review. (2012) · cites this paper as [5]
In the citing paper
“A trocar port site endometrioma might develop from the peritoneal seeding of cells because of pneumoperitoneum or from direct contact of the excised lesion with the port tract.5,8”
From Laparoscopic trocar port site endometriosis: a case report and brief literature review. (2012) · cites this paper as [5]
In the citing paper
“Medical therapy is also used in the treatment of scar endometriosis and includes nonsteroidal anti-inflammatory agents, oral contraceptives, gonadotropin-releasing hormone analogues, aromatase inhibitors, and radiofrequency ablation therapy.5”
From Laparoscopic trocar port site endometriosis: a case report and brief literature review. (2012) · cites this paper as [5]
In the citing paper
“The differential diagnosis of surgical scar endometriosis is broad and is often confused with other pathologic conditions, such as a suture granuloma, abscess, inguinal or incisional hernia, soft-tissue sarcoma, desmoid tumor, lipoma, metastatic tumor, and sebaceous cyst.”
From Laparoscopic trocar port site endometriosis: a case report and brief literature review. (2012) · cites this paper as [5]
In the citing paper
“Scar endometriosis (SE), although described in literature, is extremely rare.1,2”
From Scar endometriosis: A series of 3 cases (2016) · cites this paper as [1]
In the citing paper
“A trocar port site endometrioma may arise from direct contact between the excised lesion and the port tract or by peritoneal seeding of cells due to pneumoperitoneum [21,43].”
From Insights Into Laparoscopic Port Site Complications: A Comprehensive Review (2024) · cites this paper as [43]
In the citing paper
“In patients with the typical presentation of a palpable mass, cyclic pain, and a prior port site scar, this diagnosis is typically not difficult to make. This is particularly true in cases of gynecologic procedures that expose the uterine cavity or treat pelvic endometriosis [43].”
From Insights Into Laparoscopic Port Site Complications: A Comprehensive Review (2024) · cites this paper as [43]
Citations
Cited by
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Abdominal wall endometriosis in the cesarean section surgical scar: A potential diagnostic pitfall
Özel, L., Sağıroğlu, J., Unal, A., Ünal, E., Güneş, P., Başkent, E., Aka, N., Titiz, M. İ., & Tüfekçi, E. C. (2012) · Journal of obstetrics and gynaecology research · doi:10.1111/j.1447-0756.2011.01739.x · Cited by 83
“These data seem to be in agreement with their previous supposition of a possible interaction between previous abdominal surgery and the mechanisms of endometriosis development; however, in a recent study performed on fifteen patients with scar endometriosis, eight of the lesions were seen to be located on the right si…”
ResultAbdominal wall endometriosis: an update in clinical, imagistic features, and management options
Grigore, M., Socolov, D., Pavaleanu, I., Scripcariu, I., Grigore, A. M., & Micu, R. (2017) · Medical Ultrasonography · doi:10.11152/mu-1248 · Cited by 55
“Often a general surgeon consults on AWE cases, and it is important that not only gynecologists but also general surgeons are familiar with this entity [34].”
BackgroundLaparoscopic trocar port site endometriosis: a case report and brief literature review.
Emre, A., Akbulut, S., Yilmaz, M., & Bozdag, Z. (2012) · International Surgery · doi:10.9738/cc124.1 · Cited by 49
Self-citationYela, D. A., Trigo, L., & Benetti-Pinto, C. L. (2017) · Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics · doi:10.1055/s-0037-1603965 · Cited by 35
An unusual cause of acute appendicitis
Emre, A., Akbulut, S., Yılmaz, M. B., et al. (2012) · International Journal of Surgery Case Reports · doi:10.1016/j.ijscr.2012.07.018 · Cited by 34
Self-citationClinical manifestations of abdominal wall endometriosis: a single center experience
Kang, J., Baek, J., Lee, W., Cho, T. H., Lee, J. N., Lee, W. K., & Chung, M. (2012) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-012-2565-2 · Cited by 24
Abdominal Wall Endometriosis: A Case Report
Saliba, C., Jaafoury, H., Hajj, M. E., et al. (2019) · Cureus · doi:10.7759/cureus.4061 · Cited by 22
“Medical therapy including NSAIDs, oral contraceptives, gonadotropin-releasing hormone analogues and aromatase inhibitors are used and show improvements in symptoms with no change in the lesion size [6].”
BackgroundInfluentialCesarean scar endometrioma: Case series
Çöl, C. (2014) · World Journal of Clinical Cases · doi:10.12998/wjcc.v2.i5.133 · Cited by 21
(2015) · Europe PMC (PubMed Central) · Cited by 20
Abdominal and perineal scar endometriosis: Retrospective study on 40 cases
Matalliotakis, M., Matalliotaki, C., Zervou, M. I., Krithinakis, K., Goulielmos, G. N., & Kalogiannidis, I. A. (2020) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2020.06.054 · Cited by 21
Scar endometriosis: A series of 3 cases
Tangri, M. K., Lele, P., Bal, H., Tewari, R., & Majhi, D. (2016) · Medical Journal Armed Forces India · doi:10.1016/j.mjafi.2016.07.002 · Cited by 18
Port site endometrioma: a rare cause of abdominal wall pain following laparoscopic surgery
Siddiqui, Z. A., Husain, F., Siddiqui, Z., & Siddiqui, M. (2017) · BMJ Case Reports · doi:10.1136/bcr-2017-219291 · Cited by 14
Mixed endometrioid and clear cell carcinoma arising from laparoscopic trocar site endometriosis
Tsuruga, T., Hirata, T., Akiyama, I., Matsumoto, Y., Oda, K., Fujii, T., & Osuga, Y. (2019) · Journal of Obstetrics and Gynaecology Research · doi:10.1111/jog.14014 · Cited by 13
“laparotomy, trocar site endometriosis may have developed from peritoneal seeding of endometriotic cells because of pneumoperitoneum or from direct contact of excised endometriotic lesions with the abdominal wall.(6,14) Port site endometriosis is most likely derived from endometriotic cells and not the eutopic endometr…”
BackgroundFerjaoui, M. A., Arfaoui, R., Khedhri, S., Abdessamia, K., Amine, H. M., Hajjami, K., Azri, R., Benghalia, M., Monia, M., Rachdi, R., et al. (2021) · International Journal of Surgery Case Reports · doi:10.1016/j.ijscr.2021.106507 · Cited by 13
“Non-steroidal anti-inflammatory agents are recommended to treat pain related to abdominal wall endometriosis location and to facilitate surgical excision by decreasing inflammation surrounding the lesions [16].”
BackgroundRazakamanantsoa, L., Bodard, S., Najdawi, M., Dabi, Y., Bendifallah, S., Touboul, C., Lehrer, R., Agbonon, R., Giuseppe, R. D., Barral, M., et al. (2024) · Journal of Minimally Invasive Gynecology · doi:10.1016/j.jmig.2024.06.007 · Cited by 14
Gruber, T. M., Ortlieb, L., Henrich, W., & Mechsner, S. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13020414 · Cited by 9
“Recurrence rates can be as low as 1% [24] and as high as 13% [25].”
BackgroundAbdominal Wall Endometrioma after Laparoscopic Operation of Uterine Endometriosis
Vukšić, T., Rastović, P., & Dragišić, V. (2016) · Case Reports in Surgery · doi:10.1155/2016/5843179 · Cited by 8
Scar endometriosis, a form of abdominal wall endometriosis–a neglected obstetrical complication?
Gruber, T. M., Lange, K., Ebeling, G. S., Henrich, W., & Mechsner, S. (2024) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-024-07834-2 · Cited by 11
“Women reported pain in 41% [19] up to 100% [14, 16] of the cases often described as cyclical [13, 14, 20, 21].”
InfluentialTandon, P., Juneja, S. K., & Chopra, I. (2016) · International Journal of Applied and Basic Medical Research · doi:10.4103/2229-516x.192586 · Cited by 7
“[2] A study by Akbulut et al.[3] in 2010 reported the incidence as 0.1% of women who undergo a cesarean section.”
BackgroundInfluentialEndometriosis in a post-laparoscopic scar – case report and literature review
Chmaj-Wierzchowska, K., Pięta, B., Czerniak, T., & Opala, T. (2014) · Ginekologia Polska · doi:10.17772/gp/1737 · Cited by 6
“Author: Year Patient age Previous surgery (laparoscopy) Time interval (months) Location of complication Denton G [23] 1990 37 sterilization 12 Umbilical area Healy J [27] 1995 23 diagnostic 9 Umbilical area Martínez-Serna T [28] 1998 35 diagnostic/laparotomy 11 Suprapubic area Majeski J [24] 2004 44 myomectomy 84 Umbi…”
MethodInsights Into Laparoscopic Port Site Complications: A Comprehensive Review
Chandra J, N., Manivasagam, S. S., Choudhary, S., Manocha, P., & Reddy, B. H. (2024) · Cureus · doi:10.7759/cureus.63431 · Cited by 5
Wasserman, P. L., Kurra, C., Taylor, K., Wells, B., Sharma, A., & Leon, A. (2018) · Cureus · doi:10.7759/cureus.3778 · Cited by 5
Endometriosis in postoperative scar
Protection, S. O. M. A. C. H., Mishina, A., Гладун, С. Е., et al. (2013) · Novosti hirurgii · doi:10.18484/2305-0047.2013.3.116 · Cited by 3
Lee, M. M. H., Robson, N., & Carpenter, T. T. (2011) · Gynecological Surgery · doi:10.1007/s10397-011-0678-4 · Cited by 3
“Scar endometriosis can also occur after hysterectomies, laparotomy and even laparoscopy for ovarian cystectomy or appendectomy [7, 8].”
BackgroundEndometriosis of the meso-appendix mimicking appendicitis: A case report
Kinoo, S. M., Ramkelawon, V. V., & Singh, B. (2016) · South African Journal of Obstetrics and Gynaecology · doi:10.7196/sajog.995 · Cited by 2
“The two main hypotheses proposed for the development of endometriosis are multipotential mesenchymal cells undergoing metaplasia into endometriosis and endometrial cells being implanted from retrograde menstruation through the fallopian tubes.[4]”
BackgroundScar endometriosis is a gynecological complication that general surgeons have to deal with
Aytaç, H. Ö., Aytaç, P. Ç., & Parlakgümüş, H. A. (2015) · Clinical and Experimental Obstetrics & Gynecology · doi:10.12891/ceog1827.2015 · Cited by 2
An unusual case of laparoscopic appendicectomy scar site endometriosis
Kala, P. G., Elumalai, N., Sridharan, S., & Bupathy, A. (2022) · International Journal of Reproduction Contraception Obstetrics and Gynecology · doi:10.18203/2320-1770.ijrcog20221953 · Cited by 1
Cesarean Section Scar Endometriosis: A Case Report From Sudan
Elkhazein, M. E. M. A., Ahmed, S., Ahmed, M. B., Ismail, M. A., Mokhtar, T. H., Gurashi, A., & Bashir, H. (2025) · Cureus · doi:10.7759/cureus.90368 · Cited by 2
“These cells, under the influence of circulating estrogens, may proliferate and establish endometrial tissue within the scar [7].”
Bilateral catamenial pneumothorax and pulmonary emboli
Geynisman, J. M., Lekovic, J. P., & Tsai, T. (2014) · Journal of Obstetrics and Gynaecology · doi:10.3109/01443615.2014.935725 · Cited by 1
“Direct transplantation has also been proposed as a mechanism in abdominal scar endometriosis (Akbulut et al. 2010; Hensen et al. 2006).”
BackgroundKřepelka, P., Velebil, P., Feyereisl, J., & Krofta, L. (2017) · Journal of Endometriosis and Pelvic Pain Disorders · doi:10.5301/jeppd.5000300 · Cited by 1
“Pain can be cyclic or random, and the history of uterine surgery is significant (4, 9).”
BackgroundKim, D. H., & Shin, D. W. (2017) · Clinical Ultrasound · doi:10.18525/cu.2017.2.2.77 · Cited by 1
Endometriosis of Postoperative Scar
Plotski, A. (2019) · IntechOpen eBooks · doi:10.5772/intechopen.88246 · Cited by 1
“Nevertheless scar endometriosis occurs also after general surgery—appendectomy, cholecystectomy, and correction of hernias [2].”
BackgroundInfluentialOne of the rare reason of abdominal pain: abdominal wall endometriosis
Ergün, S., & Öner, K. K. (2021) · Turkish Journal of Surgery · doi:10.47717/turkjsurg.2021.4994 · Cited by 1
“Although CT or MRI is not an additional view for diagnosis, they are more useful in evaluating the extent and margins of the lesion (2,11).”
BackgroundScar Endometriosis: A Diagnostic Conundrum
Omenai, S. A., & Egbo, O. H. (2022) · OALib · doi:10.4236/oalib.1109025 · Cited by 1
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“08% of patients after obstetric or gynecologic surgery [3-5].”
BackgroundAppendicular Endometriosis: A Rare Entity
Rahman, S., Sayeed, S., & Ahmed, N. (2018) · Journal of Shaheed Suhrawardy Medical College · doi:10.3329/jssmc.v9i2.37269
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“Its appearance varies from few minimal lesions on otherwise intact pelvic organs, to massive ovarian endometriotic cysts and extensive adhesions involving bowel, bladder, and ureter ([1]).”
BackgroundCoexistence of Cesarean Scar Endometriosis and Intramuscular Endometriosis
Bozkurt (2014) · Journal of Medical Cases · doi:10.14740/jmc1728w
Bladder endometriosis. Clinical case and literature review
Guseva, A. I. (2023) · Urology reports (St - Petersburg) · doi:10.17816/uroved108019
The enigma of painful scars: abdominal and perineal scar endometriosis
Bano, S., Bhardwaj, A., Yadav, R., & Leimapokpam, S. S. (2025) · International Journal of Reproduction Contraception Obstetrics and Gynecology · doi:10.18203/2320-1770.ijrcog20251250
Metadata
- Authors
- Akbulut, S., Mahsuni Sevinc, M., Bakir, S., Cakabay, B., & Sezgin, A.
- Affiliations
- Diyarbakır Gazi Yaşargil Eğitim ve Araştırma Hastanesi (TR)
- Department of Surgery, Diyarbakir, Turkey.
- Department of Pathology, Diyarbakir Education and Research Hospital, Diyarbakir, Turkey.
- ORCID
- Akbulut, S.
- Venue
- Acta Chirurgica Belgica
- Publisher
- Informa UK Limited
- Published
- 2010-01
- Volume
- 110
- Issue
- 3
- Pages
- 303-307
- ISSN
- 0001-5458 (ISSN-L)
- OpenAlex
- W1559532452
- Cited by
- 41
- References
- 0
- Citations by year
- 2025: 2 · 2024: 4 · 2023: 1 · 2022: 2 · 2021: 2 · 2020: 2 · 2019: 3 · 2018: 2 · 2017: 6 · 2016: 5 · 2015: 2 · 2014: 4 · 2013: 1 · 2012: 4
- FWCI
- 2.27
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Acta chirurgica Belgica (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Health Sciences › Medicine › Dermatology › Dermatologic Treatments and Research
- Keywords
- scar endometriosis, abdominal wall, cesarean section, surgical excision, hormone therapy, endometriosis recurrence
- MeSH terms
- Adult, Appendectomy, Buserelin, Cesarean Section, Cicatrix, Contraceptives, Oral, Danazol, Endometriosis, Estrogen Antagonists, Female, Fertility Agents, Female, Humans, Middle Aged, Ovarian Cysts, Pain, Postoperative Complications, Retrospective Studies, Surgical Mesh, Abdominal Wall
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