Abdominal wall endometriosis is the most common location of extrapelvic endometriosis and usually occurs after cesarean section.

A wide spectrum of disorders should be considered in the differential diagnosis including²:

-neoplasms: sarcoma, desmoid tumor or metastasis;

-non-neoplastic: suture granuloma, hernia, hematoma or abscess.

However, abdominal wall endometriosis should always be the prime consideration in patients with an abdominal wall mass near a cesarean section scar and the classical history of cyclical pain⁵.

Scar endometriosis is a term given to endometriosis occurring in a Cesarian section scar. It can be located in the skin, subcutaneous tissue, rectus muscle/sheath, intraperitoneally, or in the uterine myometrium (within uterine scar)¹.

The reported incidence of abdominal scar endometriosis following Cesarean section is 0.03-0.6% ³.

Patients may complain of tenderness to palpation and a raised, unsightly hypertrophic scar. Most patients have cyclical pain (up to 70%)⁴. The pain is usually intermittent and associated with the patient's menstrual cycle but it may be constant in nature. Some reports state that only as low as 20% of the patients exhibited cyclical symptoms. The overlying skin may be hyperpigmented due to deposition of hemosiderin. Some patients may be asymptomatic².

Sonographic features are not specific. A subcutaneous nodule having relatively irregular borders, a heterogeneous echotexture with internal scattered hyperechoic echoes surrounded by a hyperechoic ring of variable width, and vascularity may be present. Occasionally cystic changes may be present³.

Ultrasound scanner. – Affiniti 70. Phillips.

Transducer. - 4-18MHz linear array.

Scanning in both transverse and longitudinal planes.