Postcesarean section abdominal wall endometriosis: a rare case report
Open accessAbstract
Introduction and importance: Abdominal wall endometriosis (AWE) is a rare but significant complication following cesarean sections. It manifests with recurring right lower quadrant pain, particularly during menstruation, and palpable masses at the cesarean scar site. Recognizing these symptoms is critical for timely diagnosis and effective management. This report discusses the clinical manifestations, diagnostic approach, surgical intervention, and postoperative outcomes of AWE in a specific patient. Case presentation: A 28-year-old female presented with recurrent right lower quadrant pain, exacerbated during menstruation, and a palpable mass at her previous cesarean scar. Imaging revealed a well-defined 3.6 ×3 cm mass infiltrating through all layers of the abdominal wall. Clinical discussion: This case highlights the challenges of diagnosing AWE, often presenting with vague symptoms like cyclic pain and palpable masses. The primary diagnostic tool was a CT scan, with histopathological examination confirming the diagnosis. Surgical excision was performed, resulting in significant symptom relief and a low recurrence rate. Conclusion: This case underscores the importance of vigilance for AWE symptoms in patients with prior cesarean sections. Early recognition and surgical intervention are paramount for effective management and symptom alleviation
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Written from the paper’s full text.
TL;DR
This case report describes a 28-year-old woman with abdominal wall endometriosis after two cesarean sections, presenting with cyclic right lower quadrant pain and a 3.6×3 cm scar-site mass infiltrating all abdominal wall layers. Surgical excision with aponeurosis repair relieved symptoms, and the authors emphasize vigilance, imaging, histopathology, and complete excision for AWE.
Key findings
- A 28-year-old female with two prior cesarean sections, most recent in 2020, had recurrent right lower quadrant pain during menstruation for one year and a palpable mass at the cesarean scar; contrast-enhanced CT showed a 3.6×3 cm mass extending through all abdominal wall layers, including aponeurosis and peritoneum.
- Surgical excision via a small incision over the previous scar and aponeurosis repair with prolene sutures, without mesh, was performed; the patient was discharged on the first postoperative day, and sutures were removed on day 10 without complications. The abstract states histopathological examination confirmed the diagnosis.
- The paper cites AWE incidence after cesarean section of 0.03–0.4%, endometriosis in 5–10% of all women, extra-pelvic endometriosis at <12% of reported cases, a pooled recurrence rate of 4.5% after complete excision, and cyclic pain in only 57% of patients.
- Follow-up was planned at 2 weeks, 1 month, 3 months, 6 months, and 1 year postsurgery to monitor recovery and recurrence; no actual recurrence outcomes are reported in this text.
Methods
- Design: single case report reported in line with the Surgical CAse REport (SCARE) criteria; no control group or statistical analysis is described.
- Data/sample: one 28-year-old female with a history of two cesarean sections, the most recent in 2020, presenting with recurrent right lower quadrant pain during menstruation and a palpable mass at the previous cesarean scar.
- Main analysis: clinical examination, laboratory tests, abdominal and pelvic contrast-enhanced CT, surgical excision with intraoperative findings, and planned postoperative follow-up; histopathological examination is described as the definitive diagnostic confirmation.
Limitations
- The paper does not explicitly state limitations.
- Evident from the text: this is a single case report (n=1), so findings are not generalizable and no comparative effectiveness can be assessed.
- Evident from the text: follow-up is only planned at 2 weeks, 1 month, 3 months, 6 months, and 1 year, so recurrence and long-term outcomes are not reported; the case presentation also does not provide the histopathology result details, although the abstract and discussion state histopathological examination confirmed the diagnosis.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
0 of 15 cited sources checked · 0 supported · 0 flagged
- Findingown data
Histopathological examination confirmed the diagnosis of AWE in this patient.
“The primary diagnostic tool was a CT scan, with histopathological examination confirming the diagnosis.”
Quote in the paperSubstantial claim - Findingown data
An abdominal and pelvic contrast-enhanced CT scan revealed a 3.6×3 cm mass in the right lower quadrant and suprapubic region with mild enhancement.
“An abdominal and pelvic contrast-enhanced CT scan revealed a 3.6×3 cm mass in the right lower quadrant and suprapubic region with mild enhancement (Figs 1,2).”
Quote in the paperNot a substantial claim - Findingown data
The mass extended through all the layers of the abdomen, including the aponeurosis and peritoneum.
“The mass extended through all the layers of the abdomen, including the aponeurosis and peritoneum.”
Quote in the paperNot a substantial claim - Findingown data
Physical examination revealed tenderness in the right lower quadrant and right suprapubic area, specifically over the cesarean scar.
“Physical examination revealed tenderness in the right lower quadrant and right suprapubic area, specifically over the cesarean scar, without signs of hernia.”
Quote in the paperNot a substantial claim - Findingown data
A palpable mass was detected at the cesarean scar site.
“A palpable mass was detected at the cesarean scar site.”
Quote in the paperSubstantial claim
- Findingown data
Intraoperative findings confirmed a well-circumscribed mass infiltrating through all layers of the abdominal wall.
“Intraoperative findings confirmed a well-circumscribed mass infiltrating through all layers of the abdominal wall.”
Quote in the paperNot a substantial claim - Premisecitation
Abdominal wall endometriosis (AWE) is a rare but significant complication following cesarean sections.
“Abdominal wall endometriosis (AWE) is a rare but significant complication following cesarean sections.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [4] Ding Y Zhu J. A retrospective review of abdominal wall endometriosis in Shanghai, China. Int J Gynaecol Obstet 2013; 121: 41– 44. 23352735 source
Not checked in the free run.
- Premisereasoning
Confirmation of endometriosis typically occurs through histopathological examination of surgical specimens obtained during excision, despite suggestive findings on preoperative imaging like MRI.
“Confirmation of endometriosis typically occurs through histopathological examination of surgical specimens obtained during excision, despite suggestive findings on preoperative imaging like MRI.”
Quote in the paperNot a substantial claim - Interpretationown data
AWE occurring after cesarean sections impacts muscle tissue.
“Our unique case study sheds light on AWE occurring after cesarean sections, which impacts muscle tissue, providing a comprehensive examination of symptoms, diagnosis, and the successful surgical intervention.”
Quote in the paperSubstantial claim - Premisecitation
Abdominal wall endometriosis generally has a low recurrence rate after complete excision.
“Long-term follow-up is crucial to monitor for recurrence or complications, although abdominal wall endometriosis generally has a low recurrence rate after complete excision.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [6] Simoens S Dunselman G Dirksen C. The burden of endometriosis: costs and quality of life of women with endometriosis and treated in referral centres. Hum Reprod 2012; 27: 1292– 1299. 22422778 source
Not checked in the free run.
- Interpretationown data
Surgical excision is effective for symptom relief in AWE following cesarean sections.
“It emphasizes recognizing AWE symptoms in such patients and the effectiveness of surgery for symptom relief.”
Quote in the paperSubstantial claim
- May combine two claims. 9
- Classified as probably not a substantial claim. 15
May combine two claims.
Findingnone givenOur patient experienced a palpable mass with cyclic pain.
“Our patient experienced a palpable mass with cyclic pain.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataSuture removal was performed without complications on the 10th day postoperation.
“The patient was discharged on the first postoperative day, and suture removal was performed without complications on the 10th day postoperation.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataThe patient was discharged on the first postoperative day.
“The patient was discharged on the first postoperative day, and suture removal was performed without complications on the 10th day postoperation.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataA 28-year-old female with a history of two cesarean sections, the most recent being in 2020, presented with recurring right lower quadrant pain, particularly during menstruation, over the past year.
“A 28-year-old female with a history of two cesarean sections, the most recent being in 2020, presented to our outpatient clinic with recurring right lower quadrant pain, particularly during menstruation, over the past year.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
FindingreasoningA CT scan was the primary diagnostic tool used for our patient.
“A CT scan was the primary diagnostic tool used for our patient, being both cost-effective and commonly employed.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingnone givenLaboratory tests were within normal ranges.
“Laboratory tests were within normal ranges.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationAWE that follows a previous cesarean section has an incidence of 0.03-0.4%.
“AWE that follows a previous cesarean section has an incidence of 0.03–0.4%4.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [4] Ding Y Zhu J. A retrospective review of abdominal wall endometriosis in Shanghai, China. Int J Gynaecol Obstet 2013; 121: 41– 44. 23352735 source
Not checked in the free run.
May combine two claims.
PremisecitationAWE manifests with recurring right lower quadrant pain, particularly during menstruation, and palpable masses at the cesarean scar site.
“It manifests with recurring right lower quadrant pain, particularly during menstruation, and palpable masses at the cesarean scar site.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [12] Stefanou SK Tepelenis K Stefanou CK. Abdominal wall endometriosis: a case report. J Surg Case Rep 2021; 2021: rjab055. 33854758 PMC8024042 source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe mean time interval between surgery and presentation of AWE was 2-5 years.
“The mean time interval between surgery and presentation of AWE was 2–5 years9.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [9] Tangri MK Lele P Bal H. Scar endometriosis: a series of 3 cases. Med J Armed Forces India 2016; 72(Suppl 1): S185– S188. 28050109 PMC5192233 source
Not checked in the free run.
May combine two claims.
InterpretationreasoningThe surgical intervention undertaken in this case successfully addressed the underlying pathology, providing significant relief from symptoms.
“By employing meticulous surgical excision techniques, we successfully addressed the underlying pathology, providing significant relief from symptoms and promoting patient well-being.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationMedical therapy, including NSAIDs, oral contraceptives, gonadotropin-releasing hormone analogues, and aromatase inhibitors, has been shown to alleviate symptoms without necessarily affecting the size of the lesions.
“Medical therapy, including NSAIDs, oral contraceptives, gonadotropin-releasing hormone analogues, and aromatase inhibitors, has been shown to alleviate symptoms without necessarily affecting the size of the lesions14.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [14] Piriyev E Namazov A Mahalov I. Clinical and surgical characteristics of abdominal wall endometriosis: a multicenter case series of 80 women. In vivo 2023; 37: 756– 762. 36881063 PMC10026630 source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationPrevious reports indicate a pooled recurrence rate of 4.5%.
“Previous reports indicate a pooled recurrence rate of 4.5%13.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [13] Horton JD Dezee KJ Ahnfeldt EP. Abdominal wall endometriosis: a surgeon’s perspective and review of 445 cases. Am J Surg 2008; 196: 207– 212. 18513698 source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationCyclic pain is present in only 57% of patients, with the most common symptoms being the presence of a mass or the pain itself.
“However, it’s important to note that cyclic pain is present in only 57% of patients, with the most common symptoms being the presence of a mass or the pain itself12.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [12] Stefanou SK Tepelenis K Stefanou CK. Abdominal wall endometriosis: a case report. J Surg Case Rep 2021; 2021: rjab055. 33854758 PMC8024042 source
Not checked in the free run.
May combine two claims.
PremisecitationRecurrence typically manifests with cyclic symptoms and may occur months to years following the initial surgery.
“Recurrence typically manifests with cyclic symptoms and may occur months to years following the initial surgery6.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [6] Simoens S Dunselman G Dirksen C. The burden of endometriosis: costs and quality of life of women with endometriosis and treated in referral centres. Hum Reprod 2012; 27: 1292– 1299. 22422778 source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Premisenone givenThe preferred treatment for AWE is typically a total surgical excision of nodules.
“The preferred treatment for AWE is typically a total surgical excision of nodules.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe site of AWE can lead to a variety of differential diagnoses, including hernia, abscess, lipoma, desmoid tumor, hematoma, lymphadenopathy, or malignancy.
“The site of AWE can lead to a variety of differential diagnoses, including hernia, abscess, lipoma, desmoid tumor, hematoma, lymphadenopathy, or malignancy11.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [11] Agha RA Franchi T Sohrabi C. & SCARE Group. The SCARE 2020 guideline: updating consensus Surgical CAse REport (SCARE) guidelines. International journal of surgery (London, England) 2020; 84: 226– 230. 33181358 source
Not checked in the free run.
May combine two claims.
PremisecitationMRI and fine-needle aspiration (FNA) are also useful, but the definitive diagnosis can only be confirmed by histopathological examination of the lesion.
“Additionally, MRI and fine-needle aspiration (FNA) are also useful, but the definitive diagnosis can only be confirmed by histopathological examination of the lesion9.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [9] Tangri MK Lele P Bal H. Scar endometriosis: a series of 3 cases. Med J Armed Forces India 2016; 72(Suppl 1): S185– S188. 28050109 PMC5192233 source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationAbdominal ultrasonography (US) or abdominopelvic computed tomography (CT) scans are the most commonly used preoperative diagnostic tools for suspected AWE.
“Abdominal ultrasonography (US) or abdominopelvic computed tomography (CT) scans are the most commonly used preoperative diagnostic tools for suspected AWE.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [9] Tangri MK Lele P Bal H. Scar endometriosis: a series of 3 cases. Med J Armed Forces India 2016; 72(Suppl 1): S185– S188. 28050109 PMC5192233 source
Not checked in the free run.
May combine two claims.
InterpretationreasoningSurgical excision resulted in significant symptom relief and a low recurrence rate.
“Surgical excision was performed, resulting in significant symptom relief and a low recurrence rate.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationThis case report has been reported in line with the Surgical CAse Report (SCARE) Criteria.
“This case report has been reported in line with the Surgical CAse Report (SCARE) Criteria7.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [7] Sohrabi C Mathew G Maria N. The SCARE 2023 guideline: updating consensus Surgical CAse REport (SCARE) guidelines. Int J Surg 2023; 109: 1136. 37013953 PMC10389401 source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationWide surgical excision is the treatment of choice in the literature.
“Wide surgical excision is still the treatment of choice in the literature5.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [5] Bektaş H Bilsel Y Sari YS. Abdominal wall endometrioma; a 10-year experience and brief review of the literature. J Surg Res 2010; 164: e77– e81. 20855082 source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationA systematic review comprising 455 AWE patients found that ~80% of the patients had a history of prior surgery, with cesarean sections being the most common.
“A systematic review comprising 455 AWE patients found that ~80% of the patients had a history of prior surgery, with cesarean sections being the most common.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [9] Tangri MK Lele P Bal H. Scar endometriosis: a series of 3 cases. Med J Armed Forces India 2016; 72(Suppl 1): S185– S188. 28050109 PMC5192233 source
Not checked in the free run.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The patient's two prior cesarean sections are the most consistently documented iatrogenic risk factor for abdominal wall endometriosis.
“The patient had undergone two cesarean sections, which are the most consistently documented iatrogenic risk factor for abdominal wall endometriosis [11].”
From Umbilical port-site endometriosis: a case presentation and narrative review of the literature (2026) · cites this paper as [11]
Cites
The SCARE 2020 guideline: updating consensus Surgical CAse REport (SCARE) guidelines
Agha, R. A., Franchi, T., Sohrabi, C., Mathew, G., Kerwan, A., Thoma, A., Beamish, A. J., Noureldin, A., Rao, A., Vasudevan, B., et al. (2020) · International Journal of Surgery · doi:10.1016/j.ijsu.2020.10.034 · Cited by 5,594 · cited 1× · see citing works
“The site of AWE can lead to a variety of differential diagnoses, including hernia, abscess, lipoma, desmoid tumor, hematoma, lymphadenopathy, or malignancy [11] .”
BackgroundThe SCARE 2023 guideline: updating consensus Surgical CAse REport (SCARE) guidelines
Sohrabi, C., Mathew, G., Maria, N., Kerwan, A., Franchi, T., Agha, R. A., & Collaborators (2023) · International Journal of Surgery · doi:10.1097/js9.0000000000000373 · Cited by 3,112 · cited 3× · see citing works
“Thiscasereport has been reported in line with the Surgical CAse Report (SCARE) Criteria [7] .”
BackgroundResultInfluentialSimoens, S., Dunselman, G., Dirksen, C., Hummelshoj, L., Bokor, A., Brandes, I., Brodszky, V., Canis, M., Colombo, G. L., DeLeire, T., et al. (2012) · Human Reproduction · doi:10.1093/humrep/des073 · Cited by 1,070 · see citing works
Abdominal wall endometriosis: a surgeon's perspective and review of 445 cases
Horton, J. D., DeZee, K. J., Ahnfeldt, E. P., & Wagner, M. (2008) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2007.07.035 · Cited by 391 · see citing works
Abdominal wall endometrioma; a 10-year experience and brief review of the literature.
Bektaş, H., Bilsel, Y., Sarı, Y. S., Ersöz, F., Koç, O., Deniz, M., Boran, B., & Huq, G. E. (2010) · Journal of Surgical Research · doi:10.1016/j.jss.2010.07.043 · Cited by 171 · cited 1× · see citing works
“Wide surgical excision is still the treatment of choice in the literature [5] .”
BackgroundA retrospective review of abdominal wall endometriosis in Shanghai, China.
Ding, Y., & Zhu, J. (2013) · International Journal of Gynecology & Obstetrics · doi:10.1016/j.ijgo.2012.11.011 · Cited by 80 · cited 2× · see citing works
“AWE that follows a previous cesarean section has an incidence of 0.03 – 0.4% [4] .”
BackgroundInfluentialCesarean scar endometriosis – report of two cases
Goel, P., Sood, S., Romilla, & Dalal, A. (2005) · Indian Journal of Medical Sciences · doi:10.4103/0019-5359.18967 · Cited by 58 · see citing works
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 · see citing works
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 · cited 2× · see citing works
“The mean time interval between surgery and presentation of AWE was 2 – 5 years [9] .”
BackgroundPIRIYEV, E., NAMAZOV, A., MAHALOV, I., MAMEDOVA, A., GEMER, O., SCHIERMEIER, S., & RÖMER, T. (2023) · In Vivo · doi:10.21873/invivo.13138 · Cited by 11 · cited 1× · see citing works
“Medical therapy, including NSAIDs, oral contraceptives, gonadotropin-releasing hormone analogues, and aromatase inhibitors, has been shown to alleviate symptoms without necessarily affecting the size of the lesions [14] .”
BackgroundAbdominal wall endometriosis: a case report
Stefanou, S. K., Tepelenis, K., Stefanou, C. K., Gogos-Pappas, G., Tsalikidis, C., & Vlachos, K. (2021) · Journal of Surgical Case Reports · doi:10.1093/jscr/rjab055 · Cited by 6 · see citing works
Abdominal wall endometriosis in cesarean scar: A case report
Kyejo, W., Moshi, B., Massanga, E., Ntiyakunze, G., Mgonja, M., Kaguta, M., & Mdachi, E. (2024) · SAGE Open Medical Case Reports · doi:10.1177/2050313x241237333 · Cited by 2 · cited 1× · see citing works
“The prevalence of AWE in cesarean scars is relatively low compared to other forms of endometriosis [8] .”
BackgroundAbdominal wall endometriosis (AWE): Two case reports and literature review
Christina, N. M., Candrawinata, V. S., Lie, H., & Godam, K. I. (2023) · International Journal of Surgery Case Reports · doi:10.1016/j.ijscr.2023.108495 · Cited by 1 · see citing works
Acute small bowel obstruction secondary to intestinal and appendiceal endometriosis
Ibrahim, R., Fadel, A., & Dika, Z. (2023) · Journal of Medicine Surgery and Public Health · doi:10.1016/j.glmedi.2023.100014 · Cited by 1 · cited 1× · see citing works
“Endometriosis represents a persistent medical condition characterized by the ectopic growth of endometrial tissue, which typically lines the uterine cavity beyond the con fi nes of the uterus [1] .”
BackgroundSelf-citation
Flagged first, then by citations
1 of the 15 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Keyif, M. F., Destek, S., & Keyif, B. (2025) · BMC Surgery · doi:10.1186/s12893-025-03411-9 · Cited by 1 · see citing works
Umbilical port-site endometriosis: a case presentation and narrative review of the literature
Sadlecki, P., Dejewska, K., & Walentowicz-Sadlecka, M. (2026) · Open Medicine · doi:10.1515/med-2026-1411
“The patient had undergone two cesarean sections, which are the most consistently documented iatrogenic risk factor for abdominal wall endometriosis [11].”
- Authors
- Ibrahim, R., Fadel, A., & Dika, Z.
- Affiliations
- Research Department at Saint George Hospital-Hadath
- Infectious disease Department at Saint George Hospital-Hadath
- Saint George Hospital (LB)
- Corresponding author
- Ibrahim, Rana
- Venue
- Annals of Medicine & Surgery
- Published
- 2024-08-14
- Volume
- 86
- Issue
- 10
- Pages
- 6186-6189
- ISSN
- 2049-0801 (ISSN-L)
- PMC
- PMC11444599
- OpenAlex
- W4401526911
- Semantic Scholar
- ead1d276f3fa4a228da312a00d8598b18dc18dbc
- Cited by
- 2
- References
- 15
- Citations by year
- 2026: 1 · 2025: 1
- FWCI
- 0.79
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Annals of Medicine and Surgery (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- 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 › Surgery › Intestinal and Peritoneal Adhesions
- Keywords
- abdominal wall endometriosis, cesarean section complications, cesarean section scar, right lower quadrant pain, dysmenorrhea, palpable abdominal mass, computed tomography diagnosis, surgical excision, histopathological confirmation, postoperative outcomes
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