Clinical Features of Extragenital Scar Endometriosis: A Cross-SectionalStudy

Beatriz E. Ferro, João Martins Gama, Mariana Robalo Cordeiro, Margarida Figueiredo-Dias
In: Current Women s Health Reviews · 2023 · vol. 20(2) · doi:10.2174/1573404820666230223123036 · W4321616454
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This study investigated the clinical features of abdominal wall endometriosis in 22 patients, finding cesarean scars and the umbilicus were common locations for painful, palpable masses appearing years after surgery.

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

This descriptive cross-sectional study from a Portuguese tertiary gynecology department evaluated 22 patients with histologically proven abdominal wall scar endometriosis (AWE) between 2012 and 2020, documenting clinical features, diagnostic approach, treatment, and outcomes. Most lesions were located in prior cesarean delivery scars (13/22, 59.1%) or the umbilicus (5/22, 22.7%), with all patients having a surgical history and presenting with a palpable mass; 90.9% reported painful abdominal masses and 65% had cyclic pain, with ultrasound performed in all cases. Treatment largely involved surgical resection (hormonal therapy was given to one patient). The study’s limitation is its small, single-center sample and purely descriptive design, which does not provide comparative effectiveness. This paper is centrally about endometriosis — specifically extragenital abdominal wall scar endometriosis presenting at prior surgical scars and the umbilicus.

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Abstract

Objective: Abdominal wall endometriosis (AWE) is a rare form of extragenital endometriosis that usually develops in association with a prior surgical scar. The purpose of the study was to review the clinical characteristics, diagnostic methods, treatment modalities, and outcomes of patients with AWE. Methods: A descriptive cross-sectional study was performed in a Gynecology Department of a Portuguese tertiary hospital, concerning patients with histologic-proven AWE, between January 2012 and December 2020 (n = 22). Statistical analysis was performed using IBM SPSS Statistics Version 27.00, with a significance level of p < 0.05. Results: The most common locations of extrapelvic endometrial ectopic implants were cesarean delivery scar (n = 13, 59.1%) and the umbilicus (n = 5, 22.7%). The median (range) age was 36 (30-42) years old, and all patients had a history of previous surgery but one. Nineteen patients had undergone a previous cesarean section, and the mean (range) time from surgery to the onset of symptoms was 100 (32-168) months. All patients were symptomatic and presented with a palpable mass at physical examination. The majority complained of a painful abdominal mass (n = 20, 90.9%) which was associated with cyclic pain in thirteen patients (65%). Ultrasound scan was performed in all patients and the nodules had a median size of 20.5 mm (5-93 mm). One patient received hormonal therapy and surgical resection was performed in the remaining patients. The nodule’s median (range) size was 31 (12-50) mm on gross examination. Conclusion: AWE should be considered in the presence of a previous pelvic surgery history associated with abdominal scar cyclic pain and swelling. A careful history and clinical examination are essential for diagnosis to avoid unnecessary delay before surgical intervention.
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Abstract

Objective: Abdominal wall endometriosis (AWE) is a rare form of extragenital endometriosis that usually develops in association with a prior surgical scar. The purpose of the study was to review the clinical characteristics, diagnostic methods, treatment modalities, and outcomes of patients with AWE.

Methods

A descriptive cross-sectional study was performed in a Gynecology Department of a Portuguese tertiary hospital, concerning patients with histologic-proven AWE, between January 2012 and December 2020 (n = 22). Statistical analysis was performed using IBM SPSS Statistics Version 27.00, with a significance level of p < 0.05.

Results

The most common locations of extrapelvic endometrial ectopic implants were cesarean delivery scar (n = 13, 59.1%) and the umbilicus (n = 5, 22.7%). The median (range) age was 36 (30-42) years old, and all patients had a history of previous surgery but one. Nineteen patients had undergone a previous cesarean section, and the mean (range) time from surgery to the onset of symptoms was 100 (32-168) months. All patients were symptomatic and presented with a palpable mass at physical examination. The majority complained of a painful abdominal mass (n = 20, 90.9%) which was associated with cyclic pain in thirteen patients (65%). Ultrasound scan was performed in all patients and the nodules had a median size of 20.5 mm (5-93 mm). One patient received hormonal therapy and surgical resection was performed in the remaining patients. The nodule’s median (range) size was 31 (12-50) mm on gross examination.

Conclusion

AWE should be considered in the presence of a previous pelvic surgery history associated with abdominal scar cyclic pain and swelling. A careful history and clinical examination are essential for diagnosis to avoid unnecessary delay before surgical intervention.

Keywords

Abdominal endometriosis, endometriosis, umbilical endometriosis, scar endometriosis, cesarean section, pelvic surgery. [PMID: 33763680] [http://dx.doi.org/10.3390/medicina56120727] [PMID: 33371515] [http://dx.doi.org/10.1186/s12905-019-0711-8] [PMID: 30658623] [http://dx.doi.org/10.1016/j.jmig.2017.01.005] [PMID: 28104496] [http://dx.doi.org/10.1016/j.ejogrb.2017.11.024] [PMID: 29310043] [http://dx.doi.org/10.11152/mu-1248] [PMID: 29197920] [http://dx.doi.org/10.1148/rg.2018170093] [PMID: 29320327] [http://dx.doi.org/10.17305/bjbms.2018.2659] [PMID: 29285999] [http://dx.doi.org/10.1186/s13256-020-02492-9] [PMID: 32892752] [http://dx.doi.org/10.1016/j.jmig.2019.10.004] [PMID: 31618674] [http://dx.doi.org/10.1155/2016/9302376] [http://dx.doi.org/10.1016/j.ejogrb.2020.06.054] [PMID: 32623253] [http://dx.doi.org/10.1080/01443615.2017.1305333] [PMID: 28395567] [http://dx.doi.org/10.4274/tjod.90922] [PMID: 29662714] [http://dx.doi.org/10.1016/j.jogc.2017.03.107] [PMID: 28606452] [http://dx.doi.org/10.1055/s-0037-1603965] [PMID: 28637058] [http://dx.doi.org/10.1007/s00261-018-1666-1] [PMID: 30003273] [http://dx.doi.org/10.1016/j.jmig.2019.02.021] [PMID: 30965115] [http://dx.doi.org/10.1111/jog.14522] [PMID: 33078482]

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