Abdominal wall endometriosis in a caesarean section scar

A woman in her 30s with a history of three caesarean sections was referred to gynaecology oncology for evaluation of abnormal uterine bleeding and a painful anterior abdominal wall mass located at the site of her previous caesarean scar. The mass was associated with cyclical pain coinciding with menses. Her abnormal bleeding failed conservative management with an intrauterine device and oral contraceptive pills. Physical examination revealed a Pfannenstiel scar with a 4×6 cm midline mass with overlying discolouration. The patient subsequently underwent surgical excision of the caesarean scar endometrioma with resection of the involved tissue and abdominal wall reconstruction using advancement skin flaps. Histopathologic evaluation confirmed extensive endometriosis within the caesarean scar. Surgical scar endometriosis is a rare but recognised complication of caesarean delivery, one of the most frequently performed surgical procedures in the USA. Definitive treatment involves complete surgical excision and, when necessary, abdominal wall reconstruction.