Beyond the scar: a retrospective analysis of a rare subtype of abdominal wall endometriosis with muscle fascia invasion and its surgical implications

Abdominal wall endometriosis (AWE) is a rare form of extrapelvic endometriosis, often developing after cesarean section. While typically presenting as a painful mass near surgical scars, its diagnosis is frequently delayed. This study investigates the clinical features, muscle fascia involvement, and surgical outcomes in patients with AWE. A retrospective review was performed on 21 patients with histologically confirmed AWE treated surgically at a tertiary care center between January 2016 and December 2020. Patient demographics, clinical presentation, lesion characteristics, fascia involvement, surgical techniques, and recurrence rates were analyzed. All patients had a prior cesarean section. The most common symptom was a cyclic painful mass (76.2%). Muscle fascia invasion was detected in 42.9% of cases. Polypropylene mesh repair was used in defects ≥ 3 cm. Only one recurrence (4.8%) was observed during a mean follow-up of 22 months. A strong correlation existed between physical and radiologic lesion size (r = 0.923), and between symptom duration and time since cesarean (r = 0.579). AWE should be considered in women with abdominal wall masses and cesarean history. Wide excision is effective, and mesh repair offers reliable outcomes in fascia-invading cases. Early recognition and tailored surgical planning help minimize recurrence.