Extrapelvic Endometriosis of the Rectus Abdominis Muscle After Cesarean Section: A Case Report

Arif Onur Atay, Deniz Yilmaz
In: ASIDE Case Reports · 2025 · vol. 2(3) , pp. 1–6 · doi:10.71079/aside.cr.112125316 · W7106296773
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This case report describes a 28-year-old woman with rectus abdominis muscle endometriosis three years after cesarean section, confirmed by MRI and histology after surgical excision.

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⚙ AI-generated deep summary by claude@2026-07, 2026-07-09 · read from full text ⓘ

This case report describes a 28-year-old woman with cyclic pain in the right lower abdomen appearing three years after a cesarean section, with imaging showing a 2 × 2 × 1.5 cm lesion within the right rectus abdominis muscle. MRI signal characteristics were suggestive of endometriosis, and the lesion was completely excised via a Pfannenstiel incision using approximately a 1 cm margin of healthy tissue, without mesh reconstruction. Histopathology confirmed abdominal wall endometriosis with endometrial glands and stroma within skeletal muscle fibers, and the patient remained symptom-free for 12 months of follow-up. The report is limited to a single case, so generalizability and the true diagnostic accuracy of MRI for this rare variant are not established. This paper is centrally about endometriosis — specifically extrapelvic rectus abdominis muscle endometriosis after cesarean section.

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Abstract

Abdominal wall endometriosis is an uncommon form of extra-pelvic endometriosis that typically develops in association with prior uterine surgery, particularly cesarean delivery. Among its variants, isolated involvement of the rectus abdominis muscle is exceedingly rare and may mimic other postoperative abdominal wall pathologies, resulting in delayed diagnosis. We report the case of a 28-year-old woman presenting with cyclic pain localized to the right lower abdomen, three years after a cesarean section. Magnetic resonance imaging revealed a 2 × 2 × 1.5 cm lesion within the right rectus abdominis muscle, showing signal characteristics suggestive of endometriosis. The lesion was completely excised through a Pfannenstiel incision with approximately 1 cm of healthy tissue margin, and no mesh reconstruction was required. Histopathological examination confirmed the diagnosis of endometriosis, showing endometrial glands and stroma within skeletal muscle fibers. The postoperative course was uneventful, and the patient remained symptom-free during 12 months of follow-up. This case emphasizes the need to suspect abdominal wall endometriosis in post-cesarean patients presenting with cyclic pain and a palpable abdominal wall nodule near the surgical scar. Early recognition and complete surgical excision with clear margins are essential to ensure accurate diagnosis and prevent recurrence.
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Abstract

Abdominal wall endometriosis is an uncommon form of extra-pelvic endometriosis that typically develops in association with prior uterine surgery, particularly cesarean delivery. Among its variants, isolated involvement of the rectus abdominis muscle is exceedingly rare and may mimic other postoperative abdominal wall pathologies, resulting in delayed diagnosis. We report the case of a 28-year-old woman presenting with cyclic pain localized to the right lower abdomen, three years after a cesarean section. Magnetic resonance imaging revealed a 2 × 2 × 1.5 cm lesion within the right rectus abdominis muscle, showing signal characteristics suggestive of endometriosis. The lesion was completely excised through a Pfannenstiel incision with approximately 1 cm of healthy tissue margin, and no mesh reconstruction was required. Histopathological examination confirmed the diagnosis of endometriosis, showing endometrial glands and stroma within skeletal muscle fibers. The postoperative course was uneventful, and the patient remained symptom-free during 12 months of follow-up. This case emphasizes the need to suspect abdominal wall endometriosis in post-cesarean patients presenting with cyclic pain and a palpable abdominal wall nodule near the surgical scar. Early recognition and complete surgical excision with clear margins are essential to ensure accurate diagnosis and prevent recurrence.

References

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