Abdominal Wall Endometriosis Following Cesarean Section: A Retrospective Analysis

Background: Abdominal wall endometriosis (AWE) following cesarean section (CS) is an increasingly recognized complication. Intramuscular involvement of the rectus abdominis and the management of associated fascial defects remain underreported. Methods: We retrospectively analyzed 14 consecutive women with histopathologically confirmed AWE following CS. Clinical presentation, imaging, operative technique, and follow-up outcomes were analyzed. Results: Mean age was 35.4 years (range 29-45). Three cases (21.4%) showed intramuscular rectus abdominis invasion; 11 (78.6%) were subcutaneous. Mean nodule size was 24.1 mm (range 9-45 mm). Cross-sectional imaging (MRI or CT) was obtained selectively in four patients with the largest lesions. Wide local excision with free margins was achieved in all cases. Two intramuscular cases required primary fascial repair (defects ~2 cm) without prosthetic mesh. No recurrences were detected at 12-24 months of follow-up. Conclusions: AWE following CS may involve both subcutaneous and intramuscular planes. Wide local excision with primary fascial repair is effective for small defects. Preoperative sonographic evaluation and individualized operative planning are essential for optimal outcomes.