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.
Highlights
BackgroundEndometriosis is characterized by the presence of functioning endometrial glands and stroma outside the uterine cavity
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
A total of 260 patients had scar endometriosis related to previous cesarean section, and eight patients had scar endometriosis related to another gynecological procedure, such as hysterectomy
Summary
Endometriosis is characterized by the presence of functioning endometrial glands and stroma outside the uterine cavity. It is most commonly found in the pelvis, especially the ovary or pelvic peritoneum, and can affect the fallopian tubes, bladder, sigmoid colon, and rectum [1]. Rare, it can occur in extrapelvic locations such as abdominal walls or viscera, skin, urinary system, and gastrointestinal or respiratory tracts [1,2]. The seeding of endometriotic cells plays an important role, the whole process is complex and involves estrogen stimulation after the delivery, angiogenic growth factors, chronic inflammation, and altered immunity [2]
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