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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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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endometriosis

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