Cited by 3Endometriosis Research and TreatmentGynecological conditions and treatmentsIntestinal and Peritoneal Adhesions

Resection and Abdominal Wall Reconstruction for Cesarean Scar Endometriosis

Open access
Takaya, Kento, Shido, Hirokazu, Yamazaki, Shun·2022·Case Reports in Medicine

Abstract

Introduction. Currently, there are few reports describing the use of reconstructive techniques in the treatment of cesarean scar endometriosis (CSE). Here, we report a case of CSE, a rare form of endometriosis caused by scars from obstetric and gynecological surgeries. Case Report. A 50-year-old woman became aware of a painful, deep scar mass in her lower abdomen during her menstrual period 10 years after her second cesarean section. This was diagnosed as CSE after the biopsy. Under general anesthesia, the mass, a portion of the rectus abdominis, and a 1 cm tumor-free margin were resected as a whole, and the abdominal wall was reconstructed with a soft artificial mesh. Results. No obvious recurrence or subjective symptoms were observed postoperatively or reported in the 1-year follow-up period. Discussion. Endometriosis appearing in a cesarean scar is rare; it is chiefly triggered by intraoperative mechanical implantation. In cases of surgical scar masses with a history of gynecological surgery and associated menstrual symptoms, this syndrome should be considered during diagnosis and treatment.

AI snapshot

Written from the paper’s full text.

TL;DR

A 50-year-old woman with a painful lower abdominal mass 10 years after her second cesarean section was diagnosed with cesarean scar endometriosis and treated by en bloc resection with a 1 cm margin plus abdominal wall reconstruction using artificial mesh. She had no apparent recurrence or complications during 1-year follow-up.

Key findings

  • The patient presented with a golf ball-sized hard mass under a transverse cesarean scar, with high CA19-9 (152.21 U/mL) and CA125 (48.0 U/mL); excisional biopsy confirmed endometriosis.
  • Surgery resected the mass together with part of the rectus abdominis and a 1 cm tumor-free margin, partially resected the posterior rectus sheath, and reconstructed the abdominal wall with a soft artificial mesh.
  • Histopathology showed endometrial tissue, hemosiderin, phagocytic histiocytes, and granulation tissue.
  • No obvious recurrence, subjective symptoms, or complications such as hematoma, infection, or hernia were reported during the 1-year follow-up period.

Methods

  • Single case report of a 50-year-old woman with a history of two cesarean sections and a painful lower abdominal mass appearing during menstruation.
  • Diagnostic workup included MRI, blood tests for CA19-9 and CA125, and excisional biopsy; treatment was surgical resection under general anesthesia with artificial mesh reconstruction.
  • Postoperative follow-up was clinical, with recurrence and complications assessed over 1 year.

Limitations

  • Stated: the paper notes that long-term postoperative results cannot be determined at this time and require careful follow-up.
  • Evident: this is a single case report with no comparison group, so treatment outcomes and generalizability are limited.
  • Evident: the 1-year follow-up is short for assessing recurrence or late mesh-related complications.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1155/2022/7330013

Cites

17 of 17 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 22 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    MRI showed a substantial mass in the lower portion of the rectus abdominis, with slightly irregular borders and hypointensity on T1WI and T2WI.

    “MRI showed a substantial mass in the lower portion of the rectus abdominis, with slightly irregular borders and hypointensity on T1WI and T2WI (Figure 2).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Excisional biopsy confirmed the diagnosis of endometriosis.

    “We performed an excisional biopsy, which confirmed the diagnosis of endometriosis.”
    Quote in the paperSubstantial claim
  • Findingown data

    High levels of CA19-9 (152.21 U/mL) and CA125 (48.0 U/mL) in a blood test, in addition to her symptoms, led to the suspicion of endometriosis.

    “The high levels of CA19-9 (152.21 U/mL) and CA125 (48.0 U/mL) in a blood test, in addition to her symptoms, led to the suspicion of endometriosis.”
    Quote in the paperNot a substantial claim
  • Premisecitation

    Only a few reports describe the use of reconstructive techniques such as abdominal wall plasty and the flap technique, to prevent recurrence and herniation.

    “only a few reports describe the use of reconstructive techniques such as abdominal wall plasty and the flap technique, to prevent recurrence and herniation [4–6].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [4] source

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  • Premisecitation

    Malignant transformation to clear cell carcinoma occurs in 1% of cases.

    “malignant transformation to clear cell carcinoma occurs in 1% of cases [10]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] source

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  • Classified as probably not a substantial claim. 16
  • May combine two claims. 15
  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The posterior sheath of the rectus abdominis was partially resected, and the abdominal wall was reconstructed by implanting a soft artificial mesh.

    “In addition, the posterior sheath of the rectus abdominis was partially resected, and the abdominal wall was reconstructed by implanting a soft artificial mesh (Figure 3).”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    MRI performed at the first hospital suggested a desmoid tumor; she was placed under observation.

    “Magnetic resonance imaging (MRI) performed at the first hospital suggested a desmoid tumor; therefore, she was placed under observation.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The mass was resected together with the rectus abdominis as a single mass, including a 1 cm margin.

    “This mass was resected together with the rectus abdominis as a single mass, including a 1 cm margin.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The mass was partially adherent to the overlying skin and firmly adherent to the underlying rectus abdominis, and there was no skin redness or heat.

    “The mass was partially adherent to the overlying skin and firmly adherent to the underlying rectus abdominis, and there was no skin redness or heat (Figure 1).”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Findingown data

    Histopathological examination of the excised specimen revealed endometrial tissue, hemosiderin, phagocytic histiocytes, and granulation tissue; hence, the patient was diagnosed with endometriosis.

    “Histopathological examination of the excised specimen revealed endometrial tissue, hemosiderin, phagocytic histiocytes, and granulation tissue; hence, the patient was diagnosed with endometriosis (Figure 4).”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    At the time of the visit, a mature scar with a transverse incision was found in the lower abdomen, and a golf ball-sized hard mass was palpable under the scar.

    “At the time of the visit, a mature scar with a transverse incision was found in the lower abdomen, and a golf ball-sized hard mass was palpable under the scar.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Findingown data

    The patient was satisfied with the results of the surgery and did not report any apparent recurrence or complications, such as hematoma, infection, or hernia, during the 1-year follow-up period.

    “The patient was satisfied with the results of the surgery and did not report any apparent recurrence or complications, such as hematoma, infection, or hernia, during the 1-year follow-up period.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    A 50-year-old woman presented with a painful lower abdominal mass that appeared during her menstrual cycle 10 years after her second cesarean section.

    “A 50-year-old woman presented with a painful lower abdominal mass that appeared during her menstrual cycle 10 years after her second cesarean section.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    After a skin incision along the scar tissue, a mass adherent to the anterior sheath of the rectus abdominis and partially infiltrating the muscle was identified.

    “After a skin incision along the scar tissue, a mass adherent to the anterior sheath of the rectus abdominis and partially infiltrating the muscle was identified.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Previous reports reviewed cases of CSE diagnosed from 1951 to 2006 and showed that the incidence of CSE was 0.08%; however, a recent (2003 to 2010) study estimated the incidence to be about 2%.

    “Previous reports reviewed cases of CSE diagnosed from 1951 to 2006 and showed that the incidence of CSE was 0.08% [1]; however, a recent (2003 to 2010) study estimated the incidence to be about 2% [9].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [1] source

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    • cites [9] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Among cases of endometriosis occurring in the abdominal wall, those occurring in postcesarean scars are relatively rare, estimated to account for approximately 0.08% of all cases of endometriosis.

    “Among cases of endometriosis occurring in the abdominal wall, those occurring in postcesarean scars are relatively rare, estimated to account for approximately 0.08% of all cases of endometriosis [1].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] source

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  • May combine two claims.

    Premisecitation

    Needle biopsies are useful for definitive diagnosis, but they may result in the implantation of new endometrial tissue.

    “While needle biopsies are useful for definitive diagnosis, it should be noted that they may result in the implantation of new endometrial tissue [14].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] source

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  • May combine two claims.

    Premisecitation

    Various imaging modalities such as ultrasonography, computed tomography, and MRI are nonspecific but can help determine the extent of the disease and assist in planning for surgical resection.

    “Various imaging modalities such as ultrasonography, computed tomography, and MRI are nonspecific but can help determine the extent of the disease and assist in planning for surgical resection [13].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The incidence of CSE is estimated to be on the rise owing to the increase in cesarean sections worldwide.

    “However, the incidence of this disease is estimated to be on the rise owing to the increase in cesarean sections worldwide [2].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    More often, patients complain of the presence of a mass (96%) and tenderness on palpation (87%).

    “More often, patients complain of the presence of a mass (96%) and tenderness on palpation (87%) [1].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Our report, in which the patient progressed without postoperative complications or recurrence, supports several previous reports that claim that appropriate resection of CSE and reconstruction with artificial mesh is useful.

    “Our report, in which the patient progressed without postoperative complications or recurrence, supports several previous reports that claim that appropriate resection of CSE and reconstruction with artificial mesh is useful [1, 6, 7].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [1] source

      Not checked in the free run.

    • cites [6] source

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    • cites [7] T. Santosh, 2016, Cytodiagnosis of scar endometriosis: a case series, Journal of Report and Images in Pathology

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Hormonal treatments such as gonadotropin-releasing hormone agonists, danazol, and progesterone have been used and provide only temporary relief, and symptoms often recur with discontinuation.

    “Hormonal treatments such as gonadotropin-releasing hormone agonists, danazol, and progesterone have been used and provide only temporary relief, and symptoms often recur with discontinuation [6].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [6] source

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  • May combine two claims.

    Premisecitation

    Use of artificial mesh for abdominal wall repair can lead to complicated wound infections and risk of mesh erosion.

    “Although the use of artificial mesh for abdominal wall repair can lead to complicated wound infections and risk of mesh erosion [16]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Scar endometriosis is rarely reported in the gynecological literature and occurs in patients who have previously undergone obstetric and gynecological surgeries such as cesarean section, hysterectomy, perineal incision, and tubal ligation.

    “Scar endometriosis is rarely reported in the gynecological literature and occurs in patients who have previously undergone obstetric and gynecological surgeries such as cesarean section, hysterectomy, perineal incision, and tubal ligation [7, 8].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [7] T. Santosh, 2016, Cytodiagnosis of scar endometriosis: a case series, Journal of Report and Images in Pathology

      Not checked in the free run.

    • cites [8] M. Paşalega, 2011, Parietal abdominal endometriosis following cesarean section, Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Long-term postoperative results cannot be determined at this time.

    “However, the long-term postoperative results cannot be determined at this time and require careful follow-up in the future.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Only approximately 20% of all patients with CSE show classic endometriosis symptoms of menstrual pain and accompanying changes in tumor size.

    “Only approximately 20% of all patients with CSE show classic endometriosis symptoms of menstrual pain and accompanying changes in tumor size [11].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Preoperative hormone therapy has been reported to be effective in reducing the size of the mass.

    “However, preoperative hormone therapy has been reported to be effective in reducing the size of the mass [17]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Our case demonstrates that accurate diagnosis of CSE, complete resection, and reconstruction with artificial mesh, can lead to good treatment outcomes and patient satisfaction.

    “Our case demonstrates that accurate diagnosis of CSE, complete resection, and reconstruction with artificial mesh, can lead to good treatment outcomes and patient satisfaction.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Endometriosis infiltrating the muscles of the abdominal wall requires en bloc resection of the underlying musculature and fascia.
    • Rests on an assumption: Artificial mesh is often chosen because it is associated with a shorter surgical time and more stable results than skin and muscle flap surgery, which is more invasive.
    • Rests on an assumption: Appropriate surgical treatment offers the best opportunity to make a definitive diagnosis and treat CSE.
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The most accepted theory is direct iatrogenic implantation of the endometrium into the wound margin during abdominal or pelvic surgery.

    “the most accepted theory is direct iatrogenic implantation of the endometrium into the wound margin during abdominal or pelvic surgery [11, 12].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [11] source

      Not checked in the free run.

    • cites [12] source

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24 of 24
  • The paper relies on this without support.

    Endometriosis infiltrating the muscles of the abdominal wall requires en bloc resection of the underlying musculature and fascia.

    “In addition, endometriosis infiltrating the muscles of the abdominal wall requires en bloc resection of the underlying musculature and fascia.”
  • The paper relies on this without support.

    Artificial mesh is often chosen because it is associated with a shorter surgical time and more stable results than skin and muscle flap surgery, which is more invasive.

    “it is often chosen as it is associated with a shorter surgical time and more stable results than skin and muscle flap surgery, which is more invasive.”
  • The paper relies on this without support.

    Appropriate surgical treatment offers the best opportunity to make a definitive diagnosis and treat CSE.

    “Appropriate surgical treatment offers the best opportunity to make a definitive diagnosis and treat CSE.”
  • The paper relies on this without support.

    Given the rarity of CSE, its diagnosis may be delayed, leading to frustration for both patients and physicians.

    “Given the rarity of CSE, its diagnosis may be delayed, leading to frustration for both patients and physicians.”
4 of 4

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?

  • CA125 negativity does not exclude endometriosis.

    “Although CA125 serves as a biomarker, its negativity does not exclude endometriosis [21].”

    From Abdominal wall endometriosis in a cesarean scar: a case report (2025) · cites this paper as [21]

    The Case Presentation (page unavailable) describes elevated CA125 (48.0 U/mL) as one reason endometriosis was suspected, supporting its use as a biomarker in this case. Neither that passage nor the Discussion (page unavailable) addresses whether a negative CA125 result can occur with endometriosis or exclude it. (LLM, conf=0.82)

    Experimental — accuracy not yet measured
  • Frozen sections are frequently used in gynecological cases for treatment of endometriosis and can be useful for suspicious masses found in plastic surgical cases.

    “Frozen sections were not used for this patient, but are frequently used in gynecological cases for treatment of endometriosis and can be useful for suspicious masses found in plastic surgical cases.31”

    From Endometriosis in Patients Undergoing Plastic Surgical Procedures: A Case Report and Review of the Literature (2024) · cites this paper as [31]

    The Case Presentation describes an excisional biopsy, and the Discussion describes needle biopsy and surgical resection for diagnosis, but neither addresses frozen sections. Searches for frozen sections and their use in gynecological or plastic-surgical cases found no relevant passage in our copy. (LLM, conf=0.74)

    Experimental — accuracy not yet measured

Cites

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Authors
Takaya, K., Shido, H., & Yamazaki, S.
Affiliations
  • Keio University (JP)
  • Yamato Municipal Hospital (JP)
Corresponding author
Takaya, Kento
Venue
Case Reports in Medicine
Publisher
Wiley
Published
2022-04-29
Volume
2022
Pages
1-4
ISSN
  • 1687-9627 (ISSN-L)
  • 1687-9635
OpenAlex
W4225147711
Cited by
3
References
17
Citations by year
2025: 2 · 2024: 1
FWCI
0.63
Type
journal article
Language
en
Open access
Locations
  • Case Reports in Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
Keio University
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 reconstruction, cesarean section scar, postoperative endometriosis

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