Une complication tardive méconnue de la césarienne : le nodule endométriosique pariétal : à partir d'une série de cas à la Polyclinique de Navarre de Pau et au CHU de Bordeaux, proposition d'une démarche diagnostique et thérapeutique appropriée pour sensibiliser les médecins généralistes

Objective: describe clinical manifestations of abdominal wall endometrioma of cesarean scar, diagnostic and therapeutic procedures and evaluate the duration of misdiagnosis. Materials and Methods: after a retrospective review of two institutions' databases, a total of 18 cases were analyzed from medical information collected in an Excel file. Result: patients are women of childbearing age and they had at least one cesarean section. The mean latent period was 37 months. Patients suffered from chronic pelvic (94%) cyclic (88%) and focused (76%) pain with a pelvic mass (61%). One patient out of three visits a general practitioner in first intention. Physical examination revealed a palpable mass in 94% of cases. Diagnosis firstly evocated by general practitioners don't included abdominal wall endometrioma in cesarean scar. 61% of patients had an ultrasonography, 17% associated with an MRI and 6% had only a MRI. Three diagnosis are still evocated before surgery: muscular mass syndrome, granuloma and endometrioma. Three patients had a medical treatment without success. Every patients had an elective wide excision of the nodule by a gynecologist (76%), an abdominal surgeon (18%) or a general surgeon (6%). Diagnosis is confirmed and no complications noticed for 88% of cases. One recurrence was observed. All patients completely recovered without relapse of symptoms. We have a mean follow‐up period of 75 months. The mean period between the beginning of the symptoms and the surgical procedure was 5.35 years with a maximum of 21 years. Conclusion: when we see a woman of childbearing age who had a cesarean section and suffers from chronic pelvic cyclic pain in general practice: it's necessary to search a parietal mass in order to eliminate the diagnostic of endometrioma of the cesarean scar.