Surgical Reconstruction of Abdominal Wall Endometriosis Post-Cesarean Section: A Monocentric Experience of a Rare Pathology
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design and Patient Selection
2.2. Surgical Procedures
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
AWE | Abdominal wall endometriosis |
CS | Cesarean section |
MRI | Magnetic resonance imaging |
CT | Computed tomography |
References
- Liu, G.; Wang, Y.; Chen, Y.; Ren, F. Malignant Transformation of Abdominal Wall Endometriosis: A Systematic Review of the Epidemiology, Diagnosis, Treatment, and Outcomes. Eur. J. Obstet. Gynecol. Reprod. Biol. 2021, 264, 363–367. [Google Scholar] [CrossRef]
- Crump, J.; Suker, A.; White, L. Endometriosis: A Review of Recent Evidence and Guidelines. Aust. J. Gen. Pract. 2024, 53, 11–18. [Google Scholar] [CrossRef]
- Khan, Z.; Zanfagnin, V.; El-Nashar, S.A.; Famuyide, A.O.; Daftary, G.S.; Hopkins, M.R. Risk Factors, Clinical Presentation, and Outcomes for Abdominal Wall Endometriosis. J. Minim. Invasive Gynecol. 2017, 24, 478–484. [Google Scholar] [CrossRef] [PubMed]
- Falcone, T. Clinical Management of Endometriosis. Semin. Reprod. Med. 2017, 35, 003–004. [Google Scholar] [CrossRef]
- Koninckx, P.R.; Ussia, A.; Wattiez, A.; Zupi, E.; Gomel, V. Risk Factors, Clinical Presentation, and Outcomes for Abdominal Wall Endometriosis. J. Minim. Invasive Gynecol. 2018, 25, 342–343. [Google Scholar] [CrossRef] [PubMed]
- Allaire, C.; Bedaiwy, M.A.; Yong, P.J. Diagnosis and Management of Endometriosis. Can. Med. Assoc. J. 2023, 195, E363–E371. [Google Scholar] [CrossRef]
- Ozel, L.; Sagiroglu, J.; Unal, A.; Unal, E.; Gunes, P.; Baskent, E.; Aka, N.; Titiz, M.I.; Tufekci, E.C. Abdominal Wall Endometriosis in the Cesarean Section Surgical Scar: A Potential Diagnostic Pitfall. J. Obstet. Gynaecol. Res. 2012, 38, 526–530. [Google Scholar] [CrossRef]
- Shim, J.Y.; Laufer, M.R. Adolescent Endometriosis: An Update. J. Pediatr. Adolesc. Gynecol. 2020, 33, 112–119. [Google Scholar] [CrossRef]
- Chapron, C.; Marcellin, L.; Borghese, B.; Santulli, P. Rethinking Mechanisms, Diagnosis and Management of Endometriosis. Nat. Rev. Endocrinol. 2019, 15, 666–682. [Google Scholar] [CrossRef]
- Falcone, T.; Flyckt-Rebecca, R. Clinical Management of Endometriosis. Obstet. Gynecol. 2018, 131, 557–571. [Google Scholar] [CrossRef]
- Hélage, S.; Rivière, L.; Buy, J.N.; Bordonné, C.; Préaux, F.; Just, P.A.; Aflak, N.; Rousset, P.; Dion, É. MRI Classification of Uterosacral Ligament Involvement in Endometriosis: The Hôtel-Dieu Classification. Br. J. Radiol. 2024, 97, 993–1002. [Google Scholar] [CrossRef]
- Grigoriadis, G.; Roman, H.; Kalaitzopoulos, D.R.; Christoforidis, N.; Pados, G.; Daniilidis, A. Diagnosis of Endometriosis by Transvaginal Ultrasound: An Online Survey of Gynecologists Practising in Greece. Cureus 2023, 15, e37950. [Google Scholar] [CrossRef] [PubMed]
- de Venecia, C.; Ascher, S.M. Pelvic Endometriosis: Spectrum of Magnetic Resonance Imaging Findings. Semin. Ultrasound CT MRI 2015, 36, 385–393. [Google Scholar] [CrossRef]
- Zanardi, R.; Del Frate, C.; Zuiani, C.; Bazzocchi, M. Staging of Pelvic Endometriosis Based on MRI Findings versus Laparoscopic Classification According to the American Fertility Society. Abdom. Imaging 2003, 28, 733–742. [Google Scholar] [CrossRef] [PubMed]
- Leyendecker, G.; Wildt, L.; Laschke, M.W.; Mall, G. Archimetrosis: The Evolution of a Disease and Its Extant Presentation: Pathogenesis and Pathophysiology of Archimetrosis (Uterine Adenomyosis and Endometriosis). Arch. Gynecol. Obstet. 2023, 307, 93–112. [Google Scholar] [CrossRef] [PubMed]
- Habiba, M.; Guo, S.W.; Benagiano, G. Are Adenomyosis and Endometriosis Phenotypes of the Same Disease Process? Biomolecules 2024, 14, 32. [Google Scholar] [CrossRef] [PubMed]
- Kurman, R.J.; Shih, I.M. The Origin and Pathogenesis of Epithelial Ovarian Cancer: A Proposed Unifying Theory. Am. J. Surg. Pathol. 2010, 34, 433–443. [Google Scholar] [CrossRef]
- Tennfjord, M.K.; Gabrielsen, R.; Tellum, T. Effect of Physical Activity and Exercise on Endometriosis-Associated Symptoms: A Systematic Review. BMC Womens Health 2021, 21, 355. [Google Scholar] [CrossRef]
- Practice Committee of the American Society for Reproductive Medicine. Treatment of Pelvic Pain Associated with Endometriosis: A Committee Opinion. Fertil. Steril. 2014, 101, 927–935. [Google Scholar] [CrossRef]
- Upadhyaya, P.; Karak, A.K.; Sinha, A.K.; Kumar, B.; Karki, S.; Agarwal, C.S. Abdominal Wall Endometriosis. J. Nepal Med. Assoc. 2010, 49, 158–160. [Google Scholar] [CrossRef]
- Rexhepi, M.; Asani, L.V.; Mulaki, L.; Koprivnjak, K.; Azemi, M. Abdominal Wall Endometriosis at the Cesarean Section Scar. Prilozi 2023, 44, 121–126. [Google Scholar] [CrossRef] [PubMed]
- Costa, J.E.F.R.; Accetta, I.; Maia, F.J.S.; de Sá, R.A.M. Abdominal Wall Endometriosis: Experience of the General Surgery Service of the Antônio Pedro University Hospital of the Universidade Federal Fluminense. Rev. Col. Bras. Cir. 2020, 47, e20202544. [Google Scholar] [CrossRef] [PubMed]
- Vintilǎ, D.; Neacşu, C.N.; Popa, P.; Vlad, N.; Târcoveanu, E.; Georgescu, S.O.; Dǎnilǎ, N. Abdominal Wall Endometriosis after Gynecologic Procedures: An under-Appreciated Diagnosis in General Surgery. Rev. Med. Chir. Soc. Med. Nat. Iasi 2008, 112, 393–397. [Google Scholar]
- Yang, E.; Chen, G.D.; Liao, Y.H. Spontaneous Abdominal Wall Endometriosis: A Case Report and Review of the Literature. Taiwan J. Obstet. Gynecol. 2023, 62, 155–157. [Google Scholar] [CrossRef]
- Thanasa, A.; Thanasa, E.; Antoniou, I.-R.; Kontogeorgis, G.; Gerokostas, E.-E.; Kamaretsos, E.; Paraoulakis, I.; Simopoulou, E.; Mousia, M.; Thanasas, I. Abdominal Wall Endometriosis: Early Diagnosis of a Rare Iatrogenic Complication Following Cesarean Section. Cureus 2024, 16, e56284. [Google Scholar] [CrossRef]
- Rindos, N.B.; Mansuria, S. Diagnosis and Management of Abdominal Wall Endometriosis: A Systematic Review and Clinical Recommendations. Obstet. Gynecol. Surv. 2017, 72, 116–122. [Google Scholar] [CrossRef]
- Zhang, P.; Sun, Y.; Zhang, C.; Yang, Y.; Zhang, L.; Wang, N.; Xu, H. Cesarean Scar Endometriosis: Presentation of 198 Cases and Literature Review. BMC Womens Health 2019, 19, 14. [Google Scholar] [CrossRef]
- Wasfie, T.; Gomez, E.; Seon, S.; Zado, B. Abdominal Wall Endometrioma after Cesarean Section: A Preventable Complication. Int. Surg. 2002, 87, 175–177. [Google Scholar]
- Durairaj, A.; Sivamani, H.; Panneerselvam, M. Surgical Scar Endometriosis: An Emerging Enigma. Cureus 2023, 15, e35089. [Google Scholar] [CrossRef]
- Teng, C.C.; Yang, H.M.; Chen, K.F.; Yang, C.J.; Chen, L.S.; Kuo, C.L. Abdominal Wall Endometriosis: An Overlooked but Possibly Preventable Complication. Taiwan. J. Obstet. Gynecol. 2008, 47, 42–48. [Google Scholar] [CrossRef] [PubMed]
- Zhong, Q.; Qin, S.; Lai, H.; Yao, S.; Chen, S. Risk Factors for Postoperative Recurrence of Cesarean Scar Endometriosis. AJOG Glob. Rep. 2024, 4, 100349. [Google Scholar] [CrossRef]
- Hocaoglu, M.; Turgut, A.; Ozdamar, O.; Aslan, A.; Demirer, S.; Usta, A.; Ekdeniz, E.; Karateke, A. Abdominal Wall Endometriosis in Patients with a History of Cesarian Section. Ann. Ital. Chir. 2018, 89, 425–430. [Google Scholar]
- Horton, J.D.; DeZee, K.J.; Ahnfeldt, E.P.; Wagner, M. Abdominal Wall Endometriosis: A Surgeon’s Perspective and Review of 445 Cases. Am. J. Surg. 2008, 196, 207–212. [Google Scholar] [CrossRef]
- Ananias, P.; Luenam, K.; Melo, J.P.; Jose, A.M.; Yaqub, S.; Turkistani, A.; Shah, A.; Mohammed, L. Cesarean Section: A Potential and Forgotten Risk for Abdominal Wall Endometriosis. Cureus 2021, 13, e17410. [Google Scholar] [CrossRef] [PubMed]
- Doroftei, B.; Armeanu, T.; Maftei, R.; Ilie, O.D.; Dabuleanu, A.M.; Condac, C. Abdominal Wall Endometriosis: Two Case Reports and Literature Review. Medicina 2020, 56, 727. [Google Scholar] [CrossRef] [PubMed]
- Foley, C.E.; Ayers, P.G.; Lee, T.T. Abdominal Wall Endometriosis. Obstet. Gynecol. Clin. N. Am. 2022, 49, 369–380. [Google Scholar] [CrossRef]
- Yarmish, G.; Sala, E.; Goldman, D.A.; Lakhman, Y.; Soslow, R.A.; Hricak, H.; Gardner, G.J.; Vargas, H.A. Abdominal Wall Endometriosis: Differentiation from Other Masses Using Features. Abdom. Radiol. 2017, 42, 1517. [Google Scholar] [CrossRef] [PubMed]
- Welch, B.T.; Ehman, E.C.; VanBuren, W.M.; Cope, A.G.; Welch, T.L.; Woodrum, D.A.; Kurup, A.N.; Burnett, T.L. Percutaneous Cryoablation of Abdominal Wall Endometriosis: The Mayo Clinic Approach. Abdom. Radiol. 2020, 45, 1813–1817. [Google Scholar] [CrossRef]
- Bartlett, D.J.; Burkett, B.J.; Burnett, T.L.; Sheedy, S.P.; Fletcher, J.G.; VanBuren, W.M. Comparison of Routine Pelvic US and MR Imaging in Patients with Pathologically Confirmed Endometriosis. Abdom. Radiol. 2020, 45, 1670–1679. [Google Scholar] [CrossRef]
- Mahdavi, A.; Forouzannia, S.A.; Goudarzi, E.; Forouzannia, S.M.; Rafiei, R.; Yousefimoghaddam, F.; Rafiei, N.; Padmehr, R. Radiofrequency Ablation: A Promising Treatment Method for Abdominal Wall Endometriosis. Cardiovasc. Interv. Radiol. 2024, 47, 1009–1014. [Google Scholar] [CrossRef]
- Jouffrieau, C.; Cazzato, R.L.; Gabriele, V.; Faller, E.; Weiss, J.; Host, A.; Garnon, J.; Garbin, O.; Gangi, A. Percutaneous Imaging-Guided Cryoablation of Endometriosis Scars of the Anterior Abdominal Wall. J. Minim. Invasive Gynecol. 2023, 30, 890–896. [Google Scholar] [CrossRef]
- Cornelis, F.; Petitpierre, F.; Lasserre, A.S.; Tricaud, E.; Dallaudière, B.; Stoeckle, E.; Le Bras, Y.; Bouzgarrou, M.; Brun, J.L.; Grenier, N. Percutaneous Cryoablation of Symptomatic Abdominal Scar Endometrioma: Initial Reports. J. Minim. Invasive Gynecol. 2014, 37, 1575–1579. [Google Scholar] [CrossRef] [PubMed]
- Maillot, J.; Brun, J.L.; Dubuisson, V.; Bazot, M.; Grenier, N.; Cornelis, F.H. Mid-Term Outcomes after Percutaneous Cryoablation of Symptomatic Abdominal Wall Endometriosis: Comparison with Surgery Alone in a Single Institution. Eur. Radiol. 2017, 27, 4298–4306. [Google Scholar] [CrossRef] [PubMed]
- Cozzolino, M.; Magnolfi, S.; Corioni, S.; Moncini, D.; Mattei, A. Abdominal Wall Endometriosis on the Right Port Site After Laparoscopy: Case Report and Literature Review. Ochsner. J. 2015, 15, 251. [Google Scholar]
- Denton, G.W.L.; Schofield, J.B.; Gallagher, P. Uncommon Complications of Laparoscopic Sterilisation. Ann. R. Coll. Surg. Engl. 1990, 72, 210. [Google Scholar] [PubMed]
- Benedetto, C.; Cacozza, D.; de Sousa Costa, D.; Coloma Cruz, A.; Tessmann Zomer, M.; Cosma, S.; Trippia, C.H.; Santos Cavalcanti, T.C.; Alves Castro, G.R.; Kondo, W. Abdominal Wall Endometriosis: Report of 83 Cases. Int. J. Gynecol. Obstet. 2022, 159, 530–536. [Google Scholar] [CrossRef]
- Pavone, M.; Seeliger, B.; Alesi, M.V.; Goglia, M.; Marescaux, J.; Scambia, G.; Ianieri, M.M. Initial experience of robotically assisted endometriosis surgery with a novel robotic system: First case series in a tertiary care center. Updat. Surg. 2023, 76, 271–277. [Google Scholar] [CrossRef] [PubMed]
- Madar, A.; Crestani, A.; Eraud, P.; Spiers, A.; Constantin, A.; Chiche, F.; Furet, E.; Collinet, P.; Touboul, C.; Merlot, B.; et al. Voiding dysfunction after surgery for colorectal deep infiltrating endometriosis: An updated systematic review and meta-analysis. Updat. Surg. 2025, 77, 739–748. [Google Scholar] [CrossRef] [PubMed]
Characteristics | Mean Standard ± Deviation (Range) |
---|---|
Age | 32.2 ± 6.4 (18–43) |
Age at C-section | 29 ± 5.7 (17–40) |
Pregnancies | 1.8 ± 0.8 (1–4) |
Parity | 1.4 ± 0.6 (1–3) |
BMI | 25.6 ± 4.2 (18.8–34.5) |
Latency period (months) | 31.7 ± 20.9 (3–85) |
Symptoms | Number (%) |
---|---|
Abdominal wall mass (palpable nodule) | 28 (90.3%) |
Cyclical pain at the abdominal wall | 25 (80.6%) |
Incision Type/Position | Number of Nodules | Percentage (%) |
---|---|---|
Pfannenstiel incision | ||
Total nodules (excluding midline incision) | 31 | 91.1% (of 34) |
–Left corner | 16 | 51.6% (of 31) |
–Middle line | 8 | 25.8% (of 31) |
–Right corner | 7 | 22.6% (of 31) |
Middle vertical incision | ||
Total nodules (excluding Pfannenstiel incision) | 3 | 8.9% (of 34) |
–Upper corner | 0 | 0.0% (of 3) |
–Middle line | 2 | 66.7% (of 3) |
–Lower corner | 1 | 33.3% (of 3) |
Case | Age | Main Symptoms | Surgical History | Number of Nodules for each Patient | Dimension of the Nodules | Imaging | Surgery | Mash | Border | Follow-up (12 Months) |
---|---|---|---|---|---|---|---|---|---|---|
1 | 30 | Palpable mass. Cyclical pain | PF | 1 | 1.8 CM | US, CT, MR | EX | NO | Free ≥1 cm | NR |
2 | 22 | Palpable mass. Cyclical pain | PF | 1 | 3.6 CM | US, MR | EX | PP | Free ≤1 cm | NR |
3 | 29 | Palpable mass. Cyclical pain | PF | 1 | 2.1 CM | US, MR | EX | PP | Free ≥1 cm | NR |
4 | 35 | Palpable mass. Cyclical pain | PF | 1 | 1.6 CM | US, CT, MR | EX | NO | Free ≤1 cm | NR |
5 | 37 | Palpable mass. Cyclical pain | 2 PF | 1 | 4.5 CM | US, CT, MR | EX | DM | Free ≤1 cm | NR |
6 | 24 | Palpable mass. Cyclical pain | PF | 1 | 1.5 CM | US, CT, MR | EX | PP | Free ≥1 cm | NR |
7 | 18 | Palpable mass. Cyclical pain | PF | 1 | 2.2 CM | US, MR | EX | PP | Free ≥ 1 cm | NR |
8 | 40 | Palpable mass. Cyclical pain | IVM | 1 | 3.3 CM | US, CT, MR | EX | PP | Free ≤1 cm | NR |
9 | 37 | Palpable mass. Cyclical pain | PF | 1 | 3.1 CM | US, MR | EX | PP | Free ≤1 cm | NR |
10 | 38 | Palpable mass. Cyclical pain | 2 PF | 1 | 4 CM | US, CT, MR | EX | PP | Free ≤1 cm | NR |
11 | 33 | Palpable mass. Cyclical pain | PF | 1 | 2.9 CM | US, CT, MR | EX | PP | free≥1 cm | NR |
12 | 32 | Palpable mass. Cyclical pain | 2 PF | 1 | 2.6 CM | US, CT, MR | EX | DM | Free ≤1 cm | NR |
13 | 34 | Palpable mass. Cyclical pain | PF | 1 | 3.2 CM | US, CT, MR | EX | PP | Free ≥1 cm | NR |
14 | 30 | Palpable mass. Cyclical pain | PF | 1 | 3.5 CM | US, CT, MR | EX | PP | Free ≤1 cm | NR |
15 | 28 | Palpable mass. Cyclical pain | PF | 1 | 1.9 CM | US, MR | EX | PP | Free ≤1 cm | NR |
16 | 29 | Palpable mass. Cyclical pain | PF | 1 | 3.6 CM | US, CT, MR | EX | PP | Free ≥1 cm | NR |
17 | 43 | Palpable mass. Cyclical pain | 1 IVM | 1 | 5.5 CM | US, CT, MR | EX | PP | Free ≤1 cm | NR |
18 | 36 | Palpable mass. Cyclical pain | PF | 2 | 1.5 CM 1.8 CM | US, CT, MR | EX | NO | Free ≤1 cm | NR |
19 | 34 | Palpable mass. Cyclical pain | PF | 1 | 1.5 CM | US, CT, MR | EX | NO | Free ≥1 cm | NR |
20 | 35 | Palpable mass. Cyclical pain | PF | 1 | 5.2 CM | US, CT, MR | EX | PP | Free ≤1 cm | NR |
21 | 39 | Palpable mass. Cyclical pain | 2 PF | 2 | 2.3 CM 2.7 CM | US, CT, MR | EX | PP | Free ≤1 cm | NR |
22 | 31 | Palpable mass. Cyclical pain | PF | 1 | 3.8 CM | US, CT, MR | EX | PP | Free ≥1 cm | NR |
23 | 21 | Palpable mass. Cyclical pain | PF | 1 | 1.7 CM | US, MR | EX | NO | Free ≤1 cm | NR |
24 | 20 | Palpable mass. Cyclical pain | PF | 2 | 1.8 CM 1.5 CM | US, CT, MR | EX | NO | Free ≤1 cm | NR |
25 | 36 | Palpable mass. Cyclical pain | PF | 1 | 4.3 CM | US, CT, MR | EX | DM | Free ≥1 cm | NR |
26 | 38 | Palpable mass. Cyclical pain | 3 PF | 1 | 2.3 CM | US, CT, MR | EX | DM | Free ≥1 cm | NR |
27 | 34 | Palpable mass. Cyclical pain | PF | 1 | 3.1 CM | US, MR | EX | PP | Free ≤1 cm | NR |
28 | 28 | Palpable mass. Cyclical pain | PF | 1 | 5.3 CM | US, MR | EX | PP | Free ≤1 cm | NR |
29 | 43 | Palpable mass. Cyclical pain | IVM | 1 | 3.7 CM | US, CT, MR | EX | PP | Free ≤1 cm | NR |
30 | 36 | Palpable mass. Cyclical pain | PF | 1 | 3 CM | US, CT, MR | EX | PP | Free ≤1 cm | NR |
31 | 29 | Palpable mass. Cyclical pain | PF | 1 | 4.5 CM | US, MR | EX | PP | Free ≤1 cm | NR |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Fernicola, A.; Calogero, A.; Peluso, G.; Santangelo, A.; Santangelo, D.; Crocetto, F.; Califano, G.; Sagnelli, C.; Cavaliere, A.; Sciarra, A.; et al. Surgical Reconstruction of Abdominal Wall Endometriosis Post-Cesarean Section: A Monocentric Experience of a Rare Pathology. J. Clin. Med. 2025, 14, 5416. https://doi.org/10.3390/jcm14155416
Fernicola A, Calogero A, Peluso G, Santangelo A, Santangelo D, Crocetto F, Califano G, Sagnelli C, Cavaliere A, Sciarra A, et al. Surgical Reconstruction of Abdominal Wall Endometriosis Post-Cesarean Section: A Monocentric Experience of a Rare Pathology. Journal of Clinical Medicine. 2025; 14(15):5416. https://doi.org/10.3390/jcm14155416
Chicago/Turabian StyleFernicola, Agostino, Armando Calogero, Gaia Peluso, Alfonso Santangelo, Domenico Santangelo, Felice Crocetto, Gianluigi Califano, Caterina Sagnelli, Annachiara Cavaliere, Antonella Sciarra, and et al. 2025. "Surgical Reconstruction of Abdominal Wall Endometriosis Post-Cesarean Section: A Monocentric Experience of a Rare Pathology" Journal of Clinical Medicine 14, no. 15: 5416. https://doi.org/10.3390/jcm14155416
APA StyleFernicola, A., Calogero, A., Peluso, G., Santangelo, A., Santangelo, D., Crocetto, F., Califano, G., Sagnelli, C., Cavaliere, A., Sciarra, A., Varlese, F., Alvigi, A., Pignatelli, D., D’Alessio, F. M., Sommese, M., Carlomagno, N., & Santangelo, M. (2025). Surgical Reconstruction of Abdominal Wall Endometriosis Post-Cesarean Section: A Monocentric Experience of a Rare Pathology. Journal of Clinical Medicine, 14(15), 5416. https://doi.org/10.3390/jcm14155416