A Clinical Analysis and Classification Prediction of 145 Cases of Abdominal Wall Endometriosis

To retrospectively analyze the clinical data of 145 patients with abdominal wall endometriosis (AWE) secondary to cesarean section and to identify clinical indicators for predicting lesion classification.

This was a retrospective observational study. We analyzed the general data and surgical details of 145 patients with AWE secondary to cesarean section, comparing three subtypes based on lesion invasion depth (Type I: subcutaneous fat; Type II: rectus muscle; Type III: peritoneal), two lesion patterns (solitary vs. multiple), and recurrence status.

Transverse incisions comprised 67.6% of cases, with higher implantation rates at the right end. Longitudinal incisions showed predominance at the lower end (66%). Type III patients were older and had longer operative times, greater blood loss, and larger lesions than Types I/II (all p < 0.05). Abdominal wall mass was the primary symptom across all types. Multiple lesion cases had a younger menarche age and longer operative time versus solitary lesions (p < 0.05). Recurrent cases had prolonged hospitalization (p < 0.05). MRI showed superior diagnostic concordance with surgery for lesion classification/sizing versus ultrasound (p < 0.05). ROC analysis identified menarche age ≤ 13.5 years as a significant predictor for multiple lesions.

In post-cesarean AWE, Type III lesions are associated with greater surgical complexity. MRI provides superior preoperative classification accuracy compared to ultrasound. An age at menarche ≤ 13.5 years is a significant predictor for multiple AWE lesions, offering a valuable tool for preoperative risk assessment.