Caesarean scar endometriosis involving the uterine wall

Endometriosis in a surgical scar is a rare but important clinical phenomenon that can lead to significant morbidity, especially in women with a history of caesarean sections. We present a case of a 35-year-old woman with chronic right iliac fossa pain and prolonged, heavy menstrual bleeding (HMB) with minimal improvement after hormonal treatment with the combined oral contraceptive pill. She had undergone two prior caesarean deliveries, and imaging raised the suspicion of utero-abdominal wall scar endometriosis at the site of the previous uterine incision. Intraoperative findings confirmed a mass extending from the abdominal wall into the uterine scar. The lesion was completely excised, and histopathology confirmed endometriosis. Post-surgical recovery was uneventful, with resolution of pain and HMB. This case highlights the importance of considering scar endometriosis in the differential diagnosis of abdominal wall masses and pain in patients following caesarean section, and underscores that surgical excision can be curative.