title: Abdominal wall endometriosis in the cesarean section surgical scar: a potential diagnostic pitfall.
abstract: OBJECTIVE
  The abdominal wall is an uncommon site of extrapelvic endometriosis. It usually develops in a previous surgical scar and should be considered in the differential diagnosis of any abdominal swelling. Classical symptoms of endometriosis may resemble abdominal wall lesions such as an incisional hernia, hematoma, granuloma, abscess or various soft tissue tumors; therefore, a definitive preoperative diagnosis is not always easy to determine in every case. The aim of this article is to review the clinical findings, imaging results and histopathology of those of our patients who have had cesarean scar endometriosis.
  
  
  METHODS
  Patients diagnosed with abdominal wall endometriosis in their surgical scars from February 2008 to March 2010 were documented. The age, parity, symptoms, previous surgeries, initial diagnosis, diagnostic modalities, definitive operation, postoperative complications, histopathological evaluations and recurrences were recorded and analyzed.
  
  
  RESULTS
  There were 18 patients with a mean age of 34.5 ± 9.6 years. All (100%) had a gradually growing nodular abdominal mass in or adjacent to their cesarean incision scars. This was often associated with pain (83.3%), either noncyclical (26.6%) or cyclical (73.3%) in nature. Ultrasonography (100%), computerized tomography with intravenous contrast (22.2%) and/or magnetic resonance imaging (66.6%) were performed on the patients. All patients underwent surgery and their masses were completely excised. The mean diameter of the removed masses was 3.9 ± 1.4 cm. The final pathological diagnosis for each case was abdominal wall endometriosis. Biannual follow-up examinations for two years revealed that each patient had a complete and uneventful recovery without recurrence.
  
  
  CONCLUSIONS
  Abdominal wall endometriosis should be considered in the differential diagnosis of masses located at cesarean section incision scars, which should be excised for definitive diagnosis and treatment.
authors.affiliation: Department of General Surgery, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey.
authors.forename: Leyla
authors.initials: L
authors.lastname: Ozel
authors.forename: Julide
authors.initials: J
authors.lastname: Sagiroglu
authors.forename: Aysun
authors.initials: A
authors.lastname: Unal
authors.forename: Ethem
authors.initials: E
authors.lastname: Unal
authors.forename: Pembegul
authors.initials: P
authors.lastname: Gunes
authors.forename: Erdem
authors.initials: E
authors.lastname: Baskent
authors.forename: Nurettin
authors.initials: N
authors.lastname: Aka
authors.forename: M Izzet
authors.initials: MI
authors.lastname: Titiz
authors.forename: E Can
authors.initials: EC
authors.lastname: Tufekci
mesh_terms: D034861:Abdominal Wall / Q000473:pathology*; D000328:Adult; D002585:Cesarean Section; D002921:Cicatrix / Q000473:pathology*; D003937:Diagnosis, Differential; D004715:Endometriosis / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D011183:Postoperative Complications / Q000175:diagnosis* / Q000601:surgery; D012008:Recurrence; D016896:Treatment Outcome