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Review
. 2021 Aug 24;13(8):e17410.
doi: 10.7759/cureus.17410. eCollection 2021 Aug.

Cesarean Section: A Potential and Forgotten Risk for Abdominal Wall Endometriosis

Patricia Ananias  1 , Kanita Luenam  1 , Joao Pedro Melo  2 , Arunima Mariya Jose  3   4 , Sayma Yaqub  5   6 , Arifa Turkistani  7 , Arpita Shah  1 , Lubna Mohammed  6
Affiliations
Review

Cesarean Section: A Potential and Forgotten Risk for Abdominal Wall Endometriosis

Patricia Ananias et al. Cureus. .

Abstract

Cesarean section endometriosis (CSE) can be caused by the iatrogenic deposition of endometrial cells, glands, and stroma during any time of the surgical procedure. It can be asymptomatic or, more frequently, resulting in chronic pain. Our article intends to provide more clinical information on CSE symptomatology, diagnosis, and preventive methods available in the literature, and discuss the malignancy transformation risk. We performed a systematic review based on the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. We included all types of study designs and selected only English articles from 2016 and forward. A total of 268 patients with abdominal wall endometriosis (AWE) were included in the final review; 260 women had CSE and eight women had endometriosis related to another gynecologic procedure. Attention for suggestive symptoms during anamnesis and the presence of abdominal nodules close to the cesarean scar should raise suspicions of scar endometriosis. In addition, abdominal ultrasonography (USG), computed tomography (CT), magnetic resonance imaging (MRI), and fine-needle aspiration (FNA) biopsy can be helpful to differentiate from other conditions such as incisional hernias, suture granulomas, or malignant tumors. However, the final diagnosis and treatment is still the complete excision of the tumor. Therefore, additional studies on pathophysiology would help with new preventive methods and less invasive therapeutic options.

Keywords: anterior abdominal wall lesion; caesarian scar; cesarean section (cs); clear cell cancer; cutaneous endometriosis; endometriosis and chronic pelvic pain; endometriosis surgery.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. PRISMA flow chart showing the methodology
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analysis.
Figure 2
Figure 2. Diagram for cesarean section scar endometriosis diagnosis
US: ultrasonography; CT: computed tomography; MRI: magnetic resonance imaging.
Figure 3
Figure 3. Pathogenesis for cesarean scar endometriosis
See this image and copyright information in PMC

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