{"paper_id":"b6c1b251-316a-436d-ac43-714723f37f77","body_text":"2557\n© Aluna Publishing\n   Wiadomości Lekarskie Medical Advances, VOLUME LXXVIII, ISSUE 12, DECEMBER 2025\nINTRODUCTION\nEndometriosis is a common disease among women \nworldwide. This disease negatively affects women’s re-\nproductive health, leads to a loss of productivity at work \nand causes significant socio-economic damage. Due to \nits nonspecific symptoms of endometriosis, misdiagno-\nsis or delayed diagnosis are usually happened which can \nlead to adverse outcomes including infertility, ectopic \npregnancy, and chronic pelvic pain. Despite heightened \nattention from the scientific community in world, the \ncauses of endometriosis and the pathogenesis of endo-\nmetriosis has not been fully elucidated to date. \nAbdominal wall endometriosis in Ukraine: A multicenter study\nAidyn G. Salmanov1,2, Volodymyr V. Artyomenko3, Victor O. Rud4, Vitalii S. Strakhovetskyi5,6, \nSvitlana M. Korniyenko3, Olga V. Gorbunova7, Serhii Yu. Vdovychenko7, Oleksandr V. Zabudskyi7, \nOrusia A. Kovalyshyn8, Olena O. Lytvak9, Viktor I. Litus7, Tetiana A. Struk10, Ihor Paliga11, \nOlexandr P . Kononets7, Igor V. Maidannyk12, Olena O. Chorna12\n1UKRAINIAN CENTER OF MATERNITY AND CHILDHOOD OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE, KYIV , UKRAINE\n2THE ZARIFA ALIYEVA INTERNATIONAL CENTER OF MEDICAL SCIENCE, KYIV , UKRAINE\n3ODESA NATIONAL MEDICAL UNIVERSITY , ODESA, UKRAINE\n4NATIONAL PIROGOV MEMORIAL MEDICAL UNIVERSITY , VINNYTSIA, UKRAINE\n5KHARKIV NATIONAL MEDICAL UNIVERSITY , KHARKIV , UKRAINE\n6MEDICAL CENTRE “ASHERA” , KHARKIV , UKRAINE\n7SHUPYK NATIONAL HEALTHCARE UNIVERSITY OF UKRAINE, KYIV , UKRAINE\n8LVIV MEDICAL UNIVERSITY , LVIV , UKRAINE\n9CLINICAL AND PREVENTIVE MEDICINE STATE INSTITUTION OF SCIENCE CENTER OF INNOVATIVE HEALTHCARE TECHNOLOGIES STATE \nADMINISTRATIVE DEPARTMENT , KYIV , UKRAINE\n10NATIONAL TECHNICAL UNIVERSITY “KHARKIV POL YTECHNIC INSTITUTE” , EDUCATIONAL AND SCIENTIFIC MEDICAL INSTITUTE, \nDEPARTMENT OF OBSTETRICS, GYNECOLOGY , AND REPRODUCTOLOGY , KHARKIV , UKRAINE\n11ANDREI KRUPYNSKYI LVIV MEDICAL ACADEMY , LVIV , UKRAINE\n12BOGOMOLETS NATIONAL MEDICAL UNIVERSITY , KYIV , UKRAINE\nABSTRACT\nAim: To estimate the incidence of abdominal walls endometriosis in Ukraine and review the clinical findings, imaging results, and histopathology of patients \nwho have had cesarean scar endometriosis.\nMaterials and Methods: We performed multicentre retrospective cohort study from January 2020 to December 2024. The study involved 27 hospitals from 10 \nregions of Ukraine and included 9,157 reproductive women who had a painful mass in their previous abdominal surgery scar area. Definitions of endometriosis \nwere adapted from the WHO. \nResults: Among 9,157 patients, 387 (4.2%) abdominal walls endometriosis (AWE) were observed.\nOf all cases 82.2% women had cesarean scar endometriosis and 17.8% had scar endometriosis related to gynecologic surgical procedure. The incidence of AWE \nassociated with history of cesarean section, gynecological abdominal hysterectomy and laparoscopic procedures was 6.3%, 2.3%, and 1.2%, respectively. The \nmain symptoms of scar endometriosis were palpable abdominal mass (100%) and cyclic pain (86.8%). The latency period between cesarean section procedure \nand of cesarean scar endometriosis (CSE) symptom onset was 31.8 ± 23.6 months. The duration between the onset of symptoms of CSE and this surgery was \n28.7 ± 25.4 months. The diagnosis of CSE was made through a histopathological examination. \nConclusions: In Ukraine abdominal wall endometriosis (AWE), is a relatively uncommon entity that usually develops at the site of a surgical scar that occurs \nafter obstetric or gynecologic surgeries. In our study the most frequently of all AWE cases was cesarean scar endometriosis. \n  KEY WORDS:  incidence, scar endometriosis, abdominal walls endometriosis, cesarean section, cesarean scar endometriosis, Ukraine\nWiad Lek. 2025;78(12):2557-2564. doi: 10.36740/WLek/215796 DOI\nORIGINAL ARTICLE\n\nAidyn G. Salmanov et al. \n2558\nPrevious studies have shown that the most common \nof endometriosis include ovarian endometriomas, \nsuperficial peritoneal disease, and deep infiltrating \nendometriosis [1, 2]. Less frequently, the disease may \nextend beyond the pelvis (extra-pelvic endometriosis). \nThe extra-pelvic sites of endometriosis include the \ngastrointestinal tract, urinary tract, upper and lower re-\nspiratory tract, umbilicus, inguinal region, and surgical \nscars of the abdominal wall, and brain [3-6].\nAccording to the literature, in women who had ob -\nstetric, gynecological (abdominal hysterectomy or lapa-\nroscope) and other abdominal surgical procedures may \ncause endometriosis [7-10]. Robert Meyer reported that \npostoperative scar endometriosis, can be caused by the \ndissemination of endometrial tissue to the wound at time \nof surgery [11]. According to the literature, abdominal wall \nendometriosis in women can occur after cesarean section, \nhysterectomy, salpingostomy, episiotomy, amniocentesis, \nlaparoscopy and other surgeries. The endometrial tissue \ncan be found at the abdominal wall musculature, or most \ncommonly in the subcutaneous tissue [5]. \nThe reason why some women develop postoperative \nscar endometriosis after surgical procedure do not is not \nfully understood. According to the literature, the risk fac-\ntors for scar endometriosis (abdominal wall endometrio-\nsis) are not well known, it has been shown that previous \ncesarean section, is the most common risk factor for this \ncondition [7, 12, 13]. The reported that, the occurrence \nof scar endometriosis has been increasing together with \nthe increase of cesarean section incidence [14].\nCesarean section is one of the most common obstetric \nsurgical procedures performed on women in Ukraine. \nHowever, studies focused on cesarean scar endometri-\nosis have not been conducted in Ukraine. A previous \nstudy has focused on the prevalence of surgical site \ninfection associated with Obstetric and gynecological \nsurgical procedures, and surgical site infections as risk \nfor the development of endometriosis [10, 15, 16]. \nAIM\nThe aim of this study was to estimate the incidence \nof abdominal walls endometriosis in Ukraine and \nreview the clinical findings, imaging results, and his-\ntopathology of patients who have had cesarean scar \nendometriosis.\nMATERIALS AND METHODS\nSTUDY DESIGN, SETTING AND PATIENTS\nWe performed multicentre retrospective cohort study \nbased of surveillance data on endometriosis in 2020-\n2024. This study was included women with abdominal \nwall endometriosis. The study involved 27 hospitals \nfrom 10 regions (Kharkiv, Kherson, Zaporizhzhia, Odessa, \nKyiv, Poltava, Vinnytsya, Lviv, Ternopil, Lutsk) of Ukraine. \nInclusion criteria: women who had obstetric, gyneco -\nlogical (abdominal hysterectomy or laparoscope) and \nother abdominal surgical procedures, and had sugges-\ntive symptoms during anamnesis and the presence of \nabdominal wall close to the surgical scar should raise \nsuspicions of endometriosis. Exclusion criteria: hernia \n(inguinal or incisional), abdominal wall tumours of other \ncauses, lipomas, haematomas, granulomas, metastases \nfrom distant tumours, and desmoid tumours, and wom-\nen who refused to sign the informed consent form.\nDEFINITION\nScar endometriosis, also referred to as abdominal wall \nendometriosis (AWE) is a disease in which tissue similar \nto the lining of the uterus (endometrium) grows on the \nabdominal wall close to the surgical scar. In this study \nthe scar endometriosis was defined as visible evidence \nof postsurgical residual of unresectable endometriotic \nlesions. Asymptomatic or latent period was defined \nas the time interval between the previous surgery \nand the onset of the symptoms. Cesarean section scar \nendometriosis is a one form of extra-pelvic endometri-\nosis where endometrial tissue implants in the surgical \nincision. Endometriosis was identified using Abdominal \nultrasonography (USG), computed tomography (CT), \nmagnetic resonance imaging (MRI), and fine-needle \naspiration (FNA) biopsy.\nDATA COLLECTION\nWe analyzed the inpatient data medical records patients \nwith scar endometriosis, also referred to as abdominal \nwall endometriosis (AWE) to identify and describe \ndemographic characteristics, clinical features, types of \nprevious obstetric (cesarean section), gynecological \n(abdominal hysterectomy or laparoscope) and other \nabdominal surgical procedures, symptoms at the time \nof presentation, imaging methods used for diagnosis, \nincluding both USG, CT and MRI, and pathology reports, \nand type of surgery for endometriosis. \nETHICS\nThe protocol for the study project has been approved \nby a suitably constituted Ethics Committee of the \nShupyk national healthcare university of Ukraine (Kyiv, \nUkraine) and that it conforms to the provisions of the \nDeclaration of Helsinki.\n\nAbdominal wall endometriosis in Ukraine: A multicenter study\n2559\nTable 1. Characteristics, symptoms, diagnostic tolls, and cesarean scar endometriosis sites of the patients (n=387) in Ukraine (2020-2024)\nVariable CSE\nn %\nAge of the patients (years), mean ± SD (range) 32.2 ± 3.4 (21.2-43.1)\nAge at cesarean section (years), mean ± SD (range) 27.3 ± 3.1 (19.4-37.1)\nLatency period (months), mean ± SD (range) 31.8 ± 23.6 (3–118)\nDuration between symptoms and surgery (months), mean ± SD (range) 28.7 ± 25.4 (1.5–176)\nBody mass index\n≥ 25 238 61.5\n< 25 149 38.5\nParity\n1 346 89.4\n2 41 10.6\nNumber of cesarean section\n1 358 92.5\n2 29 7.5\nMain complant (symptoms)\nPaniful abdominal mass 387 100.0\nCyclic pain 336 86.8\nNoncyclic pain 51 13.2\nSwelling 101 26.1\nDysmenorrhea 112 28.9\nOnset of complaints\n1 year after the cesarean section 82 21.2\n2 years after the cesarean section 204 52.7\n3 years after the cesarean section 81 20.9\n4 years after the cesarean section 20 5.2\nIncision type\nPfannenstiel 320 82.7\nVertical midline 67 17.3\nScar endometriosis site\nRight side of the scar 205 53.0\nLeft side of the scar 139 35.9\nMiddle line of the scar 43 11.1\nPrediagnosis\nAWE 332 85.8\nIncisional hernia 55 14.2\nRadiology diagnostic tools  \nUSG 387 100.0\nCT 92 23.8\nMRI 48 12.4\nUSG-guided needle biopsies 45 11.6\nAdmission\nGinecilogy 177 45.7\nGeneral surgery 210 54.3\nTreatment  \nSurgical resection 387 100.0\nCSE, Cesarean scar endometriosis USG, Ultrasonography, CT, Computed tomography, MRI, Magnetic resonance imaging\nSource: compiled by the authors of this study\n\nAidyn G. Salmanov et al. \n2560\nIn this study, a majority (82.7%) of the patients had \nundergone a Pfannenstiel incision. The vertical midline \nincision was 17.3% patients. In total, 387 abdominal wall \nendometriomas associates with cesarean section were \nexcised. A majority of the endometriomas were located \nin corner sites, including right side of the scar (53%) and \nleft side of the scar (35.9%). Endometrioma in middle \nline of the scar was 11.1% patients. Table 1 presents \nthe main characteristics, symptoms, diagnostic tolls, \nand cesarean scar endometriosis sites of the patients.\nThe latency period between cesarean section pro -\ncedure and symptom onset was 31.8  ± 23.6 (range \n3–118). Latency period based on patients’ characteris-\ntics, symptoms, and cesarean scar endometriosis sites \nshowed in Table 2.\nIn present study, of the 387 endometriomas, 89.9% \nwere located between the adipose layer and the fascia \nlayer, and 8.3% were located between the adipose layer \nand the muscular layer. Only 1.8% of all endometriomas \nwere located between the muscular layer in cesarean \nsection area. All patients who had a painful mass in \ntheir previous abdominal surgery scar area underwent \npreoperative abdominal ultrasound (USG), 23.8% un-\nderwent computed tomography (CT), 12.4% magnetic \nresonance imaging (MRI), and 11.6% received ultra-\nsound-guided needle biopsies (Table 1). In this study, \nthe diagnosis of cesarean scar endometriosis was made \nthrough a histopathological examination. All of the \npatients with cesarean scar endometriosis were treated \nsurgically and endometriomas were excised easily. \nDISCUSSION\nThe aim of this study was to estimate the incidence of \nabdominal walls endometriosis (AWE) in Ukraine and \nreview the clinical findings, imaging results, and his-\ntopathology of patients who have had cesarean scar \nendometriosis. This study expands upon the previous \nreports on endometriosis [2, 10] and is the first study to \npublish incidence of cesarean scar endometriosis (CSE) \nin Ukraine. In present study, among 9,157 patients, 387 \n(4.2%) AWE were observed. Of all cases 82.2% wom-\nen had cesarean scar endometriosis and 17.8% had \nAWE related to gynecologic surgical procedure. The \nincidence of AWE associated with history of cesarean \nsection, gynecological abdominal hysterectomy and \nlaparoscopic procedures was 6.3%, 2.3%, and 1.2%, \nrespectively. The main symptoms of AWE were palpable \nabdominal mass (100%) and cyclic pain (86.8%). The \nlatency period between cesarean section procedure \nand of cesarean scar endometriosis (CSE) symptom \nonset was 31.8 ± 23.6 months. The duration between \nthe onset of symptoms of CSE and this surgery was \nSTATISTICAL ANALYSIS\nIn present study, statistical analyses were performed us-\ning SPSS Statistics for Windows, Version 20.0. (IBM Corp., \nArmonk, NY, USA). The demographic and clinical char-\nacteristics of women were analyzed using descriptive \nmethods (means, ±). All data are presented as numbers \nand percentages. χ2 test was performed to compare the \ndifferences between groups for categorical variables. \nThe Cox model calculated 95% confidence interval (CI) \nof scar endometriosis (abdominal wall endometriosis) \nin women undergoing obstetric and gynecological, \nand other abdominal surgical procedures compared to \nthe comparison group. In this study p value <0.05 was \nconsidered statistically significant.\nRESUL TS\nThe study included 9,157 reproductive women who \nhad a painful mass in their previous abdominal surgery \nscar area. These patients had 5,047 obstetric (cesarean \nsection), 1,857 hysterectomy and 2,253 laparoscopic \nprocedures. Among 9,157 patients, 387 (4.2%) ab -\ndominal walls endometriosis (AWE) were observed. Of \nall AWE cases 318 (82.2%) women had cesarean scar \nendometriosis and 69 (17.8%) women had AWE related \nto gynecologic surgical procedure. The incidence of \nAWE associated with history of cesarean section, gy -\nnecological abdominal hysterectomy and laparoscopic \nprocedures was 6.3% [95% confidence interval (CI), 6.1-\n6.6], 2.3% (95% CI, 2.1-2.5), and 1.2% (95% CI, 1.1-1.3), \nrespectively. In this study all patients had a history of at \nleast one endometriotic nodule of the abdominal wall, \nand a histological diagnosis of endometriosis.\nThe most AWE cases (82.2%, 318/387) was diagnosed \nin cesarean section scar area. The mean age of the \npatients with AWE was 32.2 ± 3.4 years (range 21.2-\n43.1). All patients with AWE had a history of at least \none cesarean section procedure. The mean age at \ncesarean section was 27.3 ± 3.1 years (range 19.4-37.1). \nThe body mass indexes (BMI, kg/m2) of 61.5% patients \nwith cesarean scar endometriosis were ≥ 25, and those \nof 38.5% < 25. The mean BMI was 26.95 ± 3.59 kg/m 2 \n(range from 22.3 to 33.5 kg/m2). The common complaint \nof the patients with cesarean scar endometriosis was a \npalpable mass (100%) under the incision scar and cy -\nclical pain (86.8%). Noncyclic pain was 13.2% patients. \nSwelling in the incision scar area and dysmenorrhea \nhad 26.1% and 28.9% patients, respectively. In present \nstudy the latency period of cesarean scar endometriosis \nin women ranged from 3 to 118 months, with a mean of \n31.8 ± 23.6   months. The duration between the onset of \nmain symptoms of cesarean scar endometriosis and sur-\ngery was 1.5–176 (mean 28.7 ± 25.4) months (Table 1). \n\nAbdominal wall endometriosis in Ukraine: A multicenter study\n2561\nmanifestations of endometriosis account for 1–12% of \nall form (pelvic and extra-pelvic) endometriosis cases, \nwith the abdominal wall representing the most fre -\nquent extra-pelvic site [18].\nScar endometriosis, also referred to as abdominal \nwall endometriosis (AWE) is a disease in which tissue \nsimilar to the lining of the uterus (endometrium) grows \non the abdominal wall close to the surgical scar. Scar \nendometriosis is estimated to represent 0.03%-2% of \nextra-pelvic forms of the disease [19, 20]. In present \nstudy, among 9,157 patients, 387 (4.2%) scar endome-\ntriosis were observed.\nAccording to the literature, scar endometriosis \nmost commonly arises in or adjacent to surgical scars \nfollowing obstetric or gynecologic surgery involving \nlaparotomy or laparoscopy [10, 21]. Incidence of scar \nendometriosis has a very low and varied from 0.03-\n0.45% [6] to 3.5% [22]. This can be explained due to \ninconsistent epidemiological data reports and due to \n28.7 ± 25.4 months. The diagnosis of CSE was made \nthrough a histopathological examination.\nAccording to the literature, pelvic endometriosis in \nwomen involves organs or tissues in the located on \nthe outer walls of the uterus, the ovaries, the pelvic \nperitoneum, and the uterosacral ligaments cavity \n[1, 2, 10] and extra-pelvic endometriosis involves or -\ngans or tissues located outside the pelvic cavity [4-9, \n11,12]. Case reports in the literature include findings \nof extra-pelvic endometriosis in virtually every organ \nsystem and tissue in the body, including the CNS, lungs, \npleura, heart, diaphragm, gallbladder, liver, small bowel, \nappendix, colon, rectum, kidney, bladder, ureter, the \numbilicus, episiotomy scars, abdominal wall incisions, \nbiceps muscle, bone, and peripheral nerve are other \nreported sites in the literature. The true prevalence or \nincidence of extra-pelvic endometriosis is unknown. \nThe literature reports that although endometriosis \npredominantly involving pelvic structures, extra-pelvic \nTable 2. Latency period based on patients’ characteristics, symptoms, and cesarean scar endometriosis sites in Ukraine (2020-2024)\nVariable\nCSE Latency period\nn % months median (quartiles)\nAge at cesarean section (years)\n≤ 24 99 25.6 24 12–48\n25–34 271 70.0 24 12–40\n≥ 35 17 4.4 30 10–48\nParity    \nNulliparous 326 84.2 24 12–36\nMultiparous 61 15.8 21 6–48\nOne previous cesarean section    \nYes 53 13.7 24 6–48\nNo 334 86.3 24 12–36\nDysmenorrhea    \nYes 112 28.9 19 12–36\nNo 275 71.1 24 12–36\nIncision type    \nPfannenstiel 320 82.7 24 12–36\nVertical midline 67 17.3 33 24–60\nLocation of the scar endometriosis\nRight side of the scar 205 53.0 24 12–36\nLeft side of the scar 139 35.9 24 12–48\nMiddle line of the scar 43 11.1 30 24–38\nBound of the endometriomas    \nAdipose layer 348 89.9 24 12–39\nFascia layer 32 8.3 24 18–49.5\nMuscular layer 7 1.8 48 48–56\nCSE, Cesarean scar endometriosis\nSource: compiled by the authors of this study\n\nAidyn G. Salmanov et al. \n2562\nout other pathologies. Despite the abovementioned \nlimitations, our report contributes to the search for the \nbest approach for pathology of AWE. Further studies be \nvaluable in contributing to findings this study. \nCONCLUSIONS\nOur study showed that in Ukraine scar endometrio -\nsis, also referred to as abdominal wall endometriosis \n(AWE), is a relatively uncommon entity that usually de-\nvelops in the skin, subcutaneous tissues, and abdom-\ninal wall musculature at the site of a surgical scar that \noccurs after various obstetric or gynecologic surgeries. \nDespite its association with prior cesarean section, scar \nendometriosis in women remains under-recognized. \nIn our study the most frequently of all abdominal en-\ndometriosis cases was cesarean scar endometriosis. \nAbdominal wall endometriosis should be suspected in \nall women with a history of cesarean section who had \npalpable, painful abdominal mass associated with the \nmenstrual cycle. Ultrasound (transabdominal) imag-\ning in the clinical setting is a valuable tool to identify \nendometriotic foci inside the superficial tissues of the \nabdominal wall. The subcutaneous and intramuscular \nendometrioses of the abdominal wall are not rare \ngynecological conditions. The clinically diagnose of \ncesarean section scar are quite difficult to clinically \ndiagnose if the mass is not easily palpable. The use \nof computed tomography, magnetic resonance im-\naging, and fine-needle aspiration biopsy (FNA) may \nimprove the timely diagnosis of ectopic endometriotic \nlesions associated with cesarean section. Multimod-\nal imaging (USG, MRI, and CT) aids differentiation \nof scar endometriosis, but histopathology remains \ndefinitive. Early diagnosis of scar endometriosis and \nintervention are paramount to prevent complications, \nincluding malignancy. Future studies are needed on \nthe features of endometriotic masses, using with all \nmethods (USG, CT, MRI, and FNA) for screening of the \nabdominal wall, in the neighboring sites, underlying \nthe cesarean section scar to highlight small non-pal-\npable endometriotic foci.\ndiagnostic difficulties. Kaplanoglu M., et al reported \nthat the incidence of scar endometriosis of 0.03–0.4% \nfollowing cesarean sections, 1.08–2% after hysterec -\ntomies, and 0.06–0.7% post-episiotomy [23]. However, \nMishin I, et al [24] and Thanasa A, et al [25] reported \nthat in approximately 20% of cases without a history \nof abdominal surgery. In our study of all cases 82.2% \nwomen had cesarean scar endometriosis and 17.8% \nhad AWE related to gynecologic surgical procedure. \nThe incidence of scar endometriosis associated with \nhistory of cesarean section, gynecological abdominal \nhysterectomy and laparoscopic procedures was 6.3%, \n2.3%, and 1.2%, respectively.\nAccording to the literature, scar endometriosis asso-\nciated with cesarean section in women manifests as a \nfirm, painful lump near the scar that may cause cyclic \npain with the menstrual cycle and this symptoms onset \nusually occurs within three months to 9-10 years after \nsurgery [7, 8, 11,12].\nIn our study the main symptoms of cesarean scar \nendometriosis (CSE) were palpable abdominal mass \n(100%) and cyclic pain (86.8%). The latency period be-\ntween cesarean section procedure and of CSE symptom \nonset was 31.8 ± 23.6 months. The duration between \nthe onset of symptoms of CSE and this surgery was \n28.7 ± 25.4 months. The diagnosis of CSE was made \nthrough a histopathological examination.\nSTRENGTHS AND LIMITATION\nOur report is the first on the diagnosis of extrauterine \nendometriotic lesions and the prevalence of abdominal \nwall endometriosis associated with cesarean section in \nUkraine. The strengths of our study lay in having includ-\ned a highly patients who had obstetric and gynecologi-\ncal surgical procedures association with abdominal scar \nendometriosis. A limitation our study is that the mostly \nultrasound (USG) was used of diagnosis. However, using \nUSG alone without a subsequent computed tomogra-\nphy (CT) or magnetic resonance imaging (MRI) would \nnot produce a definitive diagnosis of abdominal scar \nendometriosis and would involve the risk of missing \nREFERENCES\n 1.  Smolarz B, Szyłło K, Romanowicz H. Endometriosis: Epidemiology, Classification, Pathogenesis, Treatment and Genetics (Review of \nLiterature). Int J Mol Sci. 2021;22(19):10554. doi: 10.3390/ijms221910554. DOI\n 2.  Salmanov AG, Yuzko OM, Tofan BYu, et al Epidemiology of endometriosis in Ukraine: results a multicenter study (2019-2021). Pol Merkur \nLek. 2024;52(3):277-285. doi: 10.36740/Merkur202403103. DOI\n 3.  Lameira P , Abecasis M, Palma S, et al. Catamenial pneumothorax: a rare manifestation of endometriosis. Radiol Case Rep. 2022;17(9):3119-\n3125. doi: 10.1016/j.radcr.2022.06.012. DOI\n 4.  Charatsi D, Koukoura O, Ntavela IG et al. Gastrointestinal and Urinary Tract Endometriosis: A Review on the Commonest Locations of \nExtrapelvic Endometriosis. Adv Med. 2018;2018:3461209. doi: 10.1155/2018/3461209. DOI\n\nAbdominal wall endometriosis in Ukraine: A multicenter study\n2563\n 5.  D’Agostino C, Surico D, Monga G et al. Pregnancy-related decidualization of subcutaneous endometriosis occurring in a post-caesarean \nsection scar: Case study and review of the literature. Pathol Res Pract. 2019;215(4):828-831. doi: 10.1016/j.prp.2019.01.024. DOI\n 6.  Carsote M, Terzea DC, Valea A, et al. Abdominal wall endometriosis (a narrative review). Int J Med Sci. 2020;17(4):536-542. doi: 10.7150/\nijms.38679. DOI\n 7.  Zhang P , Sun Y , Zhang C et al. Cesarean scar endometriosis: presentation of 198 cases and literature review. BMC Womens Health. \n2019;19(1):14. doi: 10.1186/s12905-019-0711-8. DOI\n 8.  Ananias P , Luenam K, Melo JP et al. Cesarean Section: A Potential and Forgotten Risk for Abdominal Wall Endometriosis. Cureus. \n2021;13(8):e17410. doi: 10.7759/cureus.17410. DOI\n 9.  Cocco G, Ricci V, Boccatonda A et al. Focused ultrasound for the diagnosis of non-palpable endometriotic lesions of the abdominal wall: \na not-uncommon surgical complication. J Ultrasound. 2020;23(2):183-187. doi: 10.1007/s40477-019-00425-x. DOI\n 10.  Salmanov AG, Artyomenko VV, Dyndar OA et al. Obstetric and gynecological surgical procedures, and surgical site infections as risk for \nthe development of endometriosis: a multicenter study. Wiad Lek. 2025;78(7):1291-1297. doi: 10.36740/WLek/208988. DOI\n 11.  Mihailovici A, Rottenstreich M, Kovel S et al. Endometriosis-associated malignant transformation in abdominal surgical scar: A PRISMA-\ncompliant systematic review. Medicine (Baltimore). 2017;96(49):e9136. doi: 10.1097/MD.0000000000009136. DOI\n 12.  Alnafisah F , Dawa SK, Alalfy S. Skin Endometriosis at the Caesarean Section Scar: A Case Report and Review of the Literature. Cureus. \n2018;10(1):e2063. doi: 10.7759/cureus.2063. DOI\n 13.  Yıldırım D, Tatar C, Doğan O et al. Post-cesarean scar endometriosis. Turk J Obstet Gynecol. 2018;15(1):33-38. doi: 10.4274/tjod.90922. DOI\n 14.  Tatli F , Gozeneli O, Uyanikoglu H et al. The clinical characteristics and surgical approach of scar endometriosis: A case series of 14 women. \nBosn J Basic Med Sci. 2018;18(3):275-278. doi: 10.17305/bjbms.2018.2659. DOI\n 15.  Salmanov AG, Vitiuk AD, Ishchak OM et al. Surgical site infection after cesarean section in Ukraine: results a multicenter study. Wiad Lek. \n2021;74(4):934-939. doi: 10.36740/WLek202104123.  DOI\n 16.  Salmanov AG, Artyomenko A, Susidko OM et al. Catheter-associated urinary tract infections after caesarean section in Ukraine: Results \na multicenter study (2020-2022). Wiad Lek. 2023;76(6):1325-1331. doi: 10.36740/WLek202306101. DOI\n 17.  Sakiris A, Fraz EN, Rajandran A et al. Rare presentations of small bowel endometriosis. DEN Open. 2024;5(1):e395. doi: 10.1002/deo2.395. DOI\n 18.  Andres MP , Arcoverde FVL, Souza CCC et al. Extrapelvic Endometriosis: A Systematic Review. J Minim Invasive Gynecol. 2020;27(2):373-\n389. doi: 10.1016/j.jmig.2019.10.004. DOI\n 19.  Audebert A. Les endométrioses iatrogènes de la femme avant la ménopause: principaux enjeux [Iatrogenic endometriosis during \nreproductive age: main issues?]. Gynecol Obstet Fertil. 2013;41(5):322-7. doi: 10.1016/j.gyobfe.2012.06.001. (French) DOI\n 20.  Turčić M, Matušan Ilijaš K, Rajković Molek K et al. Rectus Abdominis Muscle Endometriosis: A Unique Case Report with a Literature Review. \nCurr Issues Mol Biol. 2025;47(1):47. doi: 10.3390/cimb47010047. DOI\n 21.  Ecker AM, Donnellan NM, Shepherd JP et al. Abdominal wall endometriosis: 12 years of experience at a large academic institution. Am \nJ Obstet Gynecol. 2014;211(4):363.e1-5. doi: 10.1016/j.ajog.2014.04.011. DOI\n 22.  Yang E, Chen GD, Liao YH. Spontaneous Abdominal Wall Endometriosis: A Case Report and Review of the Literature. Taiwan J. Obstet. \nGynecol. 2023;62:155–157. doi: 10.1016/j.tjog.2022.07.009. DOI\n 23.  Kaplanoglu M, Kaplanoğlu DK, Dincer Ata C et al. Obstetric scar endometriosis: retrospective study on 19 cases and review of the literature. \nInt Sch Res Notices. 2014;2014:417042. doi: 10.1155/2014/417042. DOI\n 24.  Mishin I, Mishina A, Zaharia S et al. Rectus Abdominis Endometrioma after Caesarean Section. Case Rep Surg. 2016;2016:4312753. doi: \n10.1155/2016/4312753. DOI\n 25.  Thanasa A, Thanasa E, Kamaretsos E et al. Extrapelvic endometriosis located individually in the rectus abdominis muscle: a rare cause \nof chronic pelvic pain (a case report). Pan Afr Med J. 2022;42:242. doi: 10.11604/pamj.2022.42.242.36325. DOI\nThe authors wish to acknowledge all the study subjects who provided us with the information required for conducting \nthis study. The findings and conclusions in this study are those of the authors.\nCONFLICT OF INTEREST\nThe Authors declare no conflict of interest\nCORRESPONDING AUTHOR\nAidyn G. Salmanov \nUkrainian Center of Maternity and Childhood of the \nNational Academy of Medical Sciences of Ukraine\n8 Platona Mayborody St., 04050 Kyiv, Ukraine \ne-mail: mozsago@gmail.com\n\nAidyn G. Salmanov et al. \n2564\nORCID AND CONTRIBUTIONSHIP\nAidyn G. Salmanov: 0000-0002-4673-1154  \nVolodymyr V. Artyomenko: 0000-0003-2490-375X  \nVictor O. Rud: 0000-0002-0768-6477  \nVitalii S. Strakhovetskyi: 0000-0002-7528-1498  \nSvitlana M. Korniyenko: 0000-0003-3743-426X  \nOlga V. Gorbunova: 0000-0001-7323-5546  \nSergiy Yu. Vdovychenko: 0000-0002-9205-510X  \nOleksandr V. Zabudskyi: 0000-0003-1969-7031  \nOrusia A. Kovalyshyn: 0000-0002-9710-0694  \nOlena O. Lytvak: 0000 0001 5362 670X  \nViktor I. Litus: 0000-0002-1006-2489  \nTetiana A. Struk: 0009-0002-8784-1058  \nIhor Paliga: 0000-0001-8130-4185  \nOlexandr P . Kononets: 0000-0001-6605-6902  \nIgor V. Maidannyk: 0000-0003-0849-0406  \nOlena O. Chorna: 0000-0002-9137-5056  \n – Work concept and design,  – Data collection and analysis,  – Responsibility for statistical analysis,  – Writing the article,  – Critical review,  – Final approval of the article\nRECEIVED: 11.05.2025\nACCEPTED: 22.11.2025\n CREATIVE COMMONS 4.0","source_license":"public-domain-us","license_restricted":false}