Catamenial Rectus Abdominis Pain Associated with Scar Endometriosis Status-post Low Transverse Cesarean Section

Paul Wasserman, Chandana Kurra, Kristin Taylor, Brian Wells, Brian Johnston, Ashlesha Sharma, Amie Leon
Cureus · 2018 · vol. 10(12) , pp. e3778 · doi:10.7759/cureus.3778 · PMID:30854266 · PMC6395013 · W2906416490
article OA: gold CC0 ⤵ 4 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This case report details a patient with rectus abdominis scar endometriosis diagnosed four years after a low transverse cesarean section, discussing presentation, imaging, histopathology, and literature.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 ⓘ

This paper is a case report describing a 34-year-old woman with a palpable right anterior abdominal wall mass who developed catamenial (menstrual-cycle–related) focal tenderness four years after a low transverse cesarean section. Using ultrasound and contrast-enhanced MRI to characterize an intramuscular, enhancing rectus abdominis lesion near the surgical scar, the authors narrowed a differential that included inflammatory or neoplastic processes, but performed a US-guided core biopsy because imaging was not definitive; histopathology showed endometrioid glands with surrounding endometrial stroma consistent with endometriosis (with two of three characteristic findings present). The major limitation is that it is limited to a single patient’s diagnostic and histologic evidence without broader study design. This paper is centrally about endometriosis — specifically scar endometriosis in the rectus abdominis associated with a prior cesarean scar and catamenial pain.

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Abstract

Endometriosis is the presence of endometrial tissue outside of the uterine cavity. Scar endometriosis (SE), a rare occurrence, results from inadvertent extrapelvic transplantation of endometrial tissue to an incision site, such as from a low transverse cesarean section (LTCS). The reported incidence of abdominal wall scar endometriosis status-post cesarean section is 0.03 - 0.6%. We present a case of rectus abdominis scar endometriosis diagnosed four years following an LTCS. Our case report discusses the history/presentation, imaging findings, histopathology, and pertinent literature concerning abdominal wall scar endometriosis.

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endometriosis

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