Cesarean Section: A Potential and Forgotten Risk for Abdominal Wall Endometriosis

Area of Science:

• Gynecology
• Surgical Pathology
• Oncology

Background:

• Cesarean section endometriosis (CSE) results from endometrial cell, gland, and stroma displacement during cesarean delivery.
• CSE can be asymptomatic or manifest as chronic pain, significantly impacting quality of life.
• Understanding CSE is crucial for accurate diagnosis and management of abdominal wall masses.

Purpose of the Study:

• To review clinical information on Cesarean section endometriosis (CSE) symptomatology, diagnosis, and prevention.
• To discuss the potential risk of malignancy transformation in CSE.
• To synthesize current literature on abdominal wall endometriosis (AWE) following cesarean delivery.

Main Methods:

• Systematic review adhering to Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines.
• Inclusion of all study designs published in English from 2016 onwards.
• Analysis of 268 patients with abdominal wall endometriosis (AWE), predominantly CSE.

Main Results:

• Suggestive symptoms and abdominal nodules near cesarean scars raise suspicion for scar endometriosis.
• Diagnostic tools include ultrasonography (USG), CT, MRI, and FNA biopsy to differentiate from other conditions.
• Complete excision of the affected tissue remains the definitive diagnosis and treatment.

Conclusions:

• Early clinical suspicion and appropriate imaging are key for diagnosing CSE.
• Complete surgical excision is the current standard for diagnosis and treatment.
• Further research into CSE pathophysiology is needed for improved preventive and less invasive therapeutic strategies.