Dual-site concurrent abdominal wall and lower uterine cesarean scar endometriosis: a case report

Cesarean-section scar endometriosis (CSSE) is an uncommon complication in which endometrial-like tissue develops along the route of prior cesarean delivery. Abdominal wall CSSE is the most recognized presentation, whereas involvement of the uterine cesarean scar is less well-characterized. This report describes the case of a 37-year-old woman (gravida 2, para 2) with two prior cesarean deliveries who presented with cyclic left lower quadrant pain and a tender abdominal wall mass. She underwent exploratory laparotomy, total abdominal hysterectomy, bilateral salpingectomy, and excision of the abdominal wall mass. Histopathologic examination confirmed endometriosis involving both the abdominal Pfannenstiel scar and the lower uterine hysterotomy scar. This case demonstrates histopathologically confirmed endometriosis at two anatomically distinct cesarean-associated scar sites. Concurrent endometriosis may be underrecognized because uterine cesarean scars are not routinely sampled or specifically evaluated. CSSE should be considered in patients with prior cesarean delivery and cyclic incisional pain, even when preoperative imaging suggests benign pathology.