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Cited by 1Endometriosis Research and TreatmentGynecological conditions and treatmentsEctopic Pregnancy Diagnosis and Management

Abdominal Wall Endometriosis at the Cesarean Section Scar

Open access
Rexhepi, Meral, Asani, Learta Veliu, Mulaki, Luljeta, Koprivnjak, Kazimir, Azemi, Majlinda·2023·PRILOZI
DOI 10.2478/prilozi-2023-0055
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Abstract

Abdominal wall endometriosis is atypical localization of the extra-pelvic endometriosis with non-specific symptoms and is difficult for diagnosis. Cesarean scar endometriosis (CSE) is the most common type of abdominal wall endometriosis, which usually develops after obstetric operations. We report a case of a 33-year-old woman who had two previous cesarean sections presented with a mass in the subcutaneous tissue of the abdominal wall, approximately 4 cm superior to the Pfannenstiel incision, 5 years after her second lower segment caesarean section. The classic clinical presentation, imaging findings on ultrasonography and computed tomography are analyzed. Treatment with local surgical excision of the mass is discussed. The diagnosis was confirmed with histopathological analysis of the surgical sample. When it comes to the limited painful lesion in the subcutaneous tissue at the cesarean scar, with a pain intensifying during menstruation, the physician should consider cesarean scar endometriosis in women of reproductive age with a history of cesarean section.

AI snapshot

Written from the paper’s full text.

TL;DR

This case report describes a 33-year-old woman with cesarean scar endometriosis presenting 5 years after her second cesarean section as a painful abdominal wall mass that worsened during menstruation. Diagnosis was confirmed by histopathology after wide surgical excision, and she was discharged 4 days postoperatively in good condition.

Key findings

  • A 33-year-old woman with two previous cesarean sections presented with a painful subcutaneous mass at the cesarean scar; symptoms began 4 years after her second lower-segment cesarean section and worsened cyclically with menses.
  • Imaging showed a heterogeneous hypoechoic subcutaneous right paramedian mass measuring 5.7×5.3 cm on ultrasound and a 7.3×4.5 cm solid soft-tissue lesion on CT; CA-125 was elevated at 204 U/mL (reference 0–35 U/mL), while CA 19-9 and carcinoembryonic antigen were normal.
  • Wide surgical excision removed a firm mass about 5×7 cm infiltrating the rectus sheath and right rectus abdominis muscle to a depth of about 2 cm; histopathology showed endometrial glands and stroma involving fibro-adipose and muscular tissue with hemosiderin pigment.
  • The paper notes cesarean scar endometriosis is the most common abdominal wall endometriosis, with an estimated incidence of 0.03–0.4%, and that abdominal wall is the most common site of extra-pelvic endometriosis (4%).

Methods

  • Single case report of one patient managed at a gynecology department.
  • Data included obstetric history, clinical examination, routine laboratory tests, tumor markers, abdominal ultrasound, transvaginal ultrasonography, and contrast-enhanced CT.
  • Main intervention and analysis were surgical excision of the abdominal wall mass and histopathological examination of the specimen.

Limitations

  • The paper does not state limitations.
  • Evident from the text: this is a single case report, so findings are not generalizable and no comparison group or systematic follow-up is reported.
  • Evident from the text: follow-up is limited to discharge 4 days after surgery in good condition; recurrence or long-term outcomes are not reported.

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

Integrity signals

Registry

Crossref · 10.2478/prilozi-2023-0055

Cites

14 of 14 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 16 cited sources checked · 0 supported · 0 flagged

  • Findingown data
    § CASE PRESENTATION

    Ultrasound of the anterior abdominal wall showed a heterogeneous predominantly hypoechoic subcutaneous right paramedian mass attached to the rectus abdominis muscle with internal scattered hyperechoic partition and speculated margins infiltrating the surrounding tissue measuring 5.7x5.3cm located in the subcutaneous plane of the right upper abdominal quadrant at the site of the pain.

    “The ultrasound of the anterior abdominal wall showed a heterogeneous predominantly hypoechoic subcutaneous right paramedian mass attached to the rectus abdominis muscle with internal scattered hyperechoic partition and speculated margins infiltrating the surrounding tissue measuring 5.7x5.3cm located in the subcutaneous plane of the right upper abdominal quadrant at the site of the pain.”
    Quote in the paperNot a substantial claim
  • Findingown data
    § DISSCUSION

    In this case, the diagnosis of scar endometriosis was suspected before imaging based on medical history and clinical examination.

    “In our case, with careful attention to the medical history and clinical examination, a diagnosis of scar endometriosis was suspected before imaging was conducted.”
    Quote in the paperNot a substantial claim
  • Findingown data
    § CASE PRESENTATION

    Gross examination of the excised tissue revealed irregular, grayish-black fibro fatty mass with areas of congestion and hemorrhage.

    “The gross examination of the excised tissue revealed irregular, grayish-black fibro fatty mass with areas of congestion and hemorrhage (Fig. 3).”
    Quote in the paperNot a substantial claim
  • Findingown data
    § DISSCUSION

    The ultrasound and CT of the abdominal wall imaging assisted in determining the extension of the endometriosis mass, with more accurate data about the penetration, extension, and type of content of the nodule.

    “The ultrasound and CT of the abdominal wall imaging assisted us in determining the extension of the endometriosis mass, with more accurate data about the penetration, extension, and type of content of the nodule.”
    Quote in the paperSubstantial claim
  • Premisecitation
    § DISSCUSION

    The most common presentation of cutaneous endometriosis is a triad of non-malignant abdominal mass, recurring pain with menses, and previous history of abdominal surgery.

    “The most common presentation of cutaneous endometriosis is a triad of non-malignant abdominal mass, recurring pain with menses, and previous history of abdominal surgery.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Gonzalez RH, Singh MS, Hamza SA. Cutaneous Endometriosis: A Case Report and Review of the Literature. Am J Case Rep. 2021 Sep 21;22:e932493. doi: 10.12659/AJCR.932493. PMID: 34547012; PMCID: PMC8476184 source

      Not checked in the free run.

  • May combine two claims. 11
  • Classified as probably not a substantial claim. 9
  • The quote only partly states this claim. 1

  • May combine two claims.

    Findingown data
    § CASE PRESENTATION

    The lump was about 5x7 cm firm at the subcutaneous plane infiltrating the rectus sheath and penetrating the right rectus abdominis muscle to a depth of about 2 cm.

    “The lump was about 5x7 cm firm at the subcutaneous plane infil-trating the rectus sheath and penetrating the right rectus abdominis muscle to a depth of about 2 cm.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § CASE PRESENTATION

    CA-125 was elevated (204 U/mL, reference range 0-35 U/mL), while CA 19-9 and carcinoembryonic antigen were within normal ranges.

    “Of the tumor markers, the cancer antigen (CA) 125 was elevated (204 U/ mL, reference range 0-35 U/mL), while CA 19-9 and carcinoembryonic antigen were within the normal ranges.”
    Quote in the paperNot a substantial claim

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

    Findingnone given
    § CASE PRESENTATION

    The patient had undergone a lower segment cesarean section through a transversal incision five years previously due to fetal distress.

    “The patient had undergone a lower segment cesarean section through a transversal incision five years previously due to fetal distress.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given
    § CASE PRESENTATION

    The patient's pain started a day to 3 days before menses, peaked during the menstrual period, and gradually decreased after 2 to 3 days of menses.

    “The pain started a day to 3 days before the menses and peaked during the menstrual period and then gradually decreased after 2 to 3 days of the menses.”
    Quote in the paperNot a substantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data
    § CASE PRESENTATION

    A 33-year-old woman with two previous cesarean sections presented with a painful abdominal mass at the site of the cesarean scar for one year, which worsened during her menstrual cycle.

    “A 33-year-old married Roma female presented to the gynecology department at our hospital with a painful abdominal mass at the site of the cesarean scar for one year, which worsened during her menstrual cycle.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § CASE PRESENTATION

    Chocolate-colored fluid and extensive fibrosis of abdominal tissue around the scar was noticed, which was excised entirely.

    “Chocolate-colored fluid and extensive fibrosis of abdominal tissue around the scar was noticed, which was excised entirely, including the nodular portion for histopathological examination.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § CASE PRESENTATION

    CT scan with intravenous contrast showed a well-defined lesion dominantly in the right rectus abdominis muscle as a solid soft tissue mass, well-circumscribed, with irregular hypodense contents, with moderate post-contrast enhancement, measuring 7.3x4.5 cm.

    “A complimentary computed tomography (CT) scan with intravenous contrast showed a well-defined lesion dominantly in the right rectus abdominis muscle as a solid soft tissue mass, well-circumscribed, with irregular hypodense contents, with a moderate post-contrast enhancement, measuring 7.3x4.5 cm.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § CASE PRESENTATION

    On examination, an immobile mass of size around 6×5 cm was seen in the right side of the umbilical area, 5-6 cm cranial to her cesarean scar near the midline, painful to palpation and exacerbated by movement.

    “An immobile mass of size around 6×5 cm was seen in the right side of the umbilical area, 5-6 cm cranial to her cesarean scar near the midline that was painful to palpation and exacerbated by movement.”
    Quote in the paperNot a substantial claim

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

    Premisecitation
    § Abstract

    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% [5].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] Nepali R, Upadhyaya Kafle S, Pradhan T, Dhamala JN. Scar Endometriosis: A Rare Cause of Abdominal Pain. Dermatopathology (Basel). 2022 May 5;9(2):158-163. doi: 10.3390/dermatopathology9020020. PMID: 35645231; PMCID: PMC9149924. source

      Not checked in the free run.

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

    Premisecitation
    § DISSCUSION

    The mean age of patients with cesarean scar endometriosis is 35 years.

    “The mean age of patients with caesarean scar endometriosis is 35 years, and the time from surgery to endometriosis recognition varies from three months to two decades [12].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] Carsote M, Terzea DC, Valea A, Gheorghisan-Galateanu AA. Abdominal wall endometriosis (a narrative review). Int J Med Sci. 2020 Feb 10;17(4):536-542. doi: 10.7150/ijms.38679. PMID: 32174784; PMCID: PMC7053307. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § DISSCUSION

    Pfannenstiel incisions involve greater dissection of planes, more damage to longitudinal abdominal capillaries, and consequently more blood loss, which can favor implantation of endometrial cells at the edge of the operation cut.

    “Although Pfannenstiel incisions have a better cosmetic appearance and decreased association of surgical hernias, they involve greater dissections of plans, more damage to the longitudinal abdominal capillaries, and consequently more blood loss, which can favor the implantation of endometrial cells at the edge of the operation cut that is difficult to be removed during the cesarean procedure [9].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [9] Ananias P, Luenam K, Melo JP, Jose AM, Yaqub S, Turkistani A, Shah A, Mohammed L. Cesarean Section: A Potential and Forgotten Risk for Abdominal Wall Endometriosis. Cureus. 2021 Aug 24;13(8):e17410. doi: 10.7759/cureus.17410. PMID: 34589321; PMCID: PMC8459811. source

      Not checked in the free run.

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

    Premisecitation
    § DISSCUSION

    Differential diagnoses for scar endometriosis may include fibromas, lipomas, suture granulomas, incisional and ventral hernias, hematomas, abscesses, fat necrosis, lymphomas, desmoid tumors and sarcomas.

    “differential diagnoses may involve fibromas, lipomas, suture granulomas, incisional and ventral hernias, hematomas, abscesses, fat necrosis, lymphomas, desmoid tumors and sarcomas [11].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] Ramdani A, Rais K, Rockson O, Serji B, El Harroudi T. Parietal Mass: Two Case Reports of Rare Cesarean Scar Endometriosis. Cureus. 2020 Feb 8;12(2):e6918. doi: 10.7759/cureus.6918. PMID: 32190473; PMCID: PMC7061853. source

      Not checked in the free run.

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

    Premisecitation
    § DISSCUSION

    The time from surgery to recognition of cesarean scar endometriosis varies from three months to two decades.

    “The mean age of patients with caesarean scar endometriosis is 35 years, and the time from surgery to endometriosis recognition varies from three months to two decades [12].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] Carsote M, Terzea DC, Valea A, Gheorghisan-Galateanu AA. Abdominal wall endometriosis (a narrative review). Int J Med Sci. 2020 Feb 10;17(4):536-542. doi: 10.7150/ijms.38679. PMID: 32174784; PMCID: PMC7053307. source

      Not checked in the free run.

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

    Premisecitation
    § Abstract

    Endometriosis most commonly develops intraperitoneally and mainly affects the ovaries, peritoneum, uterine ligaments and rectovaginal septum.

    “Endometriosis most commonly develops intraperitoneally and mainly affects ovaries, peritoneum, uterine ligaments and rectovaginal septum [2].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] Bartłomiej B, Małgorzata S, Karolina F, Anna S. Caesarean Scar Endometriosis May Require Abdominoplasty. Clin Med Insights Case Rep. 2021 Jun 25;14:11795476211027666. doi: 10.1177/11795476211027666. PMID: 34248360; PMCID: PMC8236782. source

      Not checked in the free run.

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

    Premisecitation
    § Abstract

    The most common site of extra pelvic endometriosis is the abdominal wall (4%).

    “The most common site of extra pelvic endometriosis is the abdominal wall (4%)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] Paramythiotis D, Karlafti E, Tsomidis I, Iraklis G, Malliou P, Karakatsanis A, Antonios M. Abdominal wall endometriosis: a case report. Pan Afr Med J. 2022 Mar 10;41:193. doi: 10.11604/pamj.2022.41.193.33536. PMID: 35685105; PMCID: PMC9146603. source

      Not checked in the free run.

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

    Premisecitation
    § Abstract

    Endometriosis is a sex hormone-dependent gynecological disease in which functional and morphological endometrial tissue is present outside the uterine cavity.

    “Endometriosis is a sex hormone-dependent gynecological disease where the functional and morphological endometrial tissues are present outside the uterine cavity [1].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Purbadi S, Purwoto G, Winarto H, Nuryanto KH, Scovani L, Sotarduga GE. Case report: Caesarean scar endometriosis - A rare entity. Int J Surg Case Rep. 2021 Aug;85:106204. doi: 10.1016/j.ijscr.2021.106204. PMID: 34325300; PMCID: PMC8329506. source

      Not checked in the free run.

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

    Premisecitation
    § DISSCUSION

    The degree of pain and dimensions of scar endometriosis vary with the menstrual cycle.

    “The degree of pain and dimensions of scar endometriosis vary with the menstrual cycle [10].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Gonzalez RH, Singh MS, Hamza SA. Cutaneous Endometriosis: A Case Report and Review of the Literature. Am J Case Rep. 2021 Sep 21;22:e932493. doi: 10.12659/AJCR.932493. PMID: 34547012; PMCID: PMC8476184 source

      Not checked in the free run.

17 of 17

  • The paper relies on this without support.

    Complete excision of the endometriosis nodule is the treatment of choice for scar endometriosis.

    “The treatment of choice is the complete excision of the endometriosis nodule.”
1 of 1

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?

  • Abdominal wall endometriosis (AWE) is among the rarest forms of primary endometriosis.

    “Abdominal wall endometriosis (AWE) is among the rarest forms of primary endometriosis [20,21,22], accounting for 20% of cases, while most are secondary to obstetric and gynecological surgeries, including laparotomic, laparoscopic, or robotic procedures.”

    From Surgical Reconstruction of Abdominal Wall Endometriosis Post-Cesarean Section: A Monocentric Experience of a Rare Pathology (2025) · cites this paper as [21]

    The Abstract (page unavailable) describes abdominal wall endometriosis as an atypical extra-pelvic location, and the Conclusion calls cesarean scar endometriosis very rare. The paper does not classify abdominal wall endometriosis as a primary form or rank it among the rarest primary forms; it instead calls the abdominal wall the most common site of extra-pelvic endometriosis. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Mass location differs between abstract and case presentation

    Minor

    The abstract places the mass approximately 4 cm above the Pfannenstiel incision, while the case presentation places it 5-6 cm above the cesarean scar.

1 of 1

Cites

Flagged first, then by citations

1 of the 15 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Buscemi S, Maiorana A, Fazzotta S, Incandela D, Palumbo VD, Damiano G, Maffongelli A, Messina M, Bisso C, Anzelmo G, Curione F, Cantavenera V, Bellomo E, Raia VE, Scimeca R, Geraci G, Cudia BM, Lo Monte AI. Scar endometriosis: not a rare cause for a painful scar. Clin Ter. 2021 Mar 15;172(2):129-133.

Cited by

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Related

Authors
Rexhepi, M., Asani, L. V., Mulaki, L., Koprivnjak, K., & Azemi, M.
Affiliations
  • State University of Tetova (MK)
  • Department of Gynecology and Obstetrics , Clinical Hospital in Tetovo , RN Macedonia
ORCID
Rexhepi, Meral
Venue
PRILOZI
Publisher
Walter de Gruyter GmbH
Published
2023-12-01
Volume
44
Issue
3
Pages
121-126
ISSN
  • 0350-1914 (ISSN-L)
  • 1857-8985
DOI
10.2478/prilozi-2023-0055
OpenAlex
W4389924774
Semantic Scholar
ffc91cc91369d6744c30ad4a2978637e766fbdea
Cited by
1
References
15
Citations by year
2025: 1
FWCI
0.24
Type
journal article
Language
en
Open access
Licence
Locations
  • PRILOZI (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 › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
Keywords
abdominal wall endometriosis, extrapelvic endometriosis, cesarean section, ultrasonography, computed tomography, surgical excision, histopathological diagnosis, dysmenorrhea
MeSH terms
Adult, Cesarean Section, Cicatrix, Endometriosis, Female, Humans, Pregnancy, Ultrasonography, Abdominal Wall

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