POST-CESAREAN SCAR ENDOMETRIOSIS: LONG LATENCY, FREQUENT MISDIAGNOSIS, AND OUTCOMES OF SURGICAL EXCISION (A CASE SERIES OF 5 PATIENTS)

OBJECTIVE: To analyze cesarean scar endometriosis as a long-term complication of cesarean section and to evaluate its clinical presentation, latency period, diagnostic features, and surgical outcomes. DESIGN: Retrospective descriptive case series. SETTING: Tertiary referral medical center, 2018-2025. PARTICIPANTS: Among 36 patients treated for various forms of endometriosis during the study period, five women with histologically confirmed post-cesarean scar endometriosis were included. MAIN OUTCOME MEASURES: Latency period between cesarean section and symptom onset, diagnostic delay, depth of tissue involvement, surgical management, and recurrence during follow-up. RESULTS: Patients' age at diagnosis ranged from 31 to 42 years (mean 36.4 years). The latency period varied from 6 to 14 years (median 9 years). Four of five patients (80%) received an incorrect preliminary diagnosis at the prehospital stage. Lesion size ranged from 15 to 35 mm. Aponeurotic or muscular involvement was identified in two cases (40%), requiring extended surgical resection. Diagnostic laparoscopy performed in all patients revealed no concomitant pelvic endometriosis. Complete surgical excision with histopathological confirmation was achieved in all cases. No postoperative complications or recurrences were observed during follow-up. CONCLUSIONS: Cesarean scar endometriosis is an underrecognized long-term complication of cesarean section characterized by prolonged latency and frequent initial misdiagnosis. Thorough imaging assessment and complete surgical excision ensure favorable outcomes. Increased clinical awareness is essential for timely diagnosis.