First documented case of decidualized endometriosis on the anterior peritoneum during emergency cesarean section: a case report and literature review

Endometriosis is a chronic gynecological condition characterized by the presence of endometrial-like tissue outside the uterine cavity. Although commonly associated with pelvic pain and infertility, its incidental discovery during a cesarean section is rare. To our knowledge, we report the first documented case of decidualized endometriosis identified on the anterior peritoneum during an emergency cesarean section in a 28-year-old woman with only one previous cesarean delivery and no prior symptoms. Histopathological examination confirmed the diagnosis, revealing significant decidual changes attributable to hormonal influences during pregnancy. This case highlights the importance of thorough intraoperative inspection, even during emergency procedures, as asymptomatic and atypically located endometriotic lesions can easily be overlooked. We discuss the clinical implications of this finding and provide a review of the relevant literature.