A Clinical Analysis and Classification Prediction of 145 Cases of Abdominal Wall Endometriosis.

OBJECTIVE: To retrospectively analyze the clinical data of 145 patients with abdominal wall endometriosis (AWE) secondary to cesarean section and to identify clinical indicators for predicting lesion classification. METHODS: This was a retrospective observational study. We analyzed the general data and surgical details of 145 patients with AWE secondary to cesarean section, comparing three subtypes based on lesion invasion depth (Type I: subcutaneous fat; Type II: rectus muscle; Type III: peritoneal), two lesion patterns (solitary vs. multiple), and recurrence status. RESULTS: Transverse incisions comprised 67.6% of cases, with higher implantation rates at the right end. Longitudinal incisions showed predominance at the lower end (66%). Type III patients were older and had longer operative times, greater blood loss, and larger lesions than Types I/II (all p < 0.05). Abdominal wall mass was the primary symptom across all types. Multiple lesion cases had a younger menarche age and longer operative time versus solitary lesions (p < 0.05). Recurrent cases had prolonged hospitalization (p < 0.05). MRI showed superior diagnostic concordance with surgery for lesion classification/sizing versus ultrasound (p < 0.05). ROC analysis identified menarche age ≤ 13.5 years as a significant predictor for multiple lesions. CONCLUSION: In post-cesarean AWE, Type III lesions are associated with greater surgical complexity. MRI provides superior preoperative classification accuracy compared to ultrasound. An age at menarche ≤ 13.5 years is a significant predictor for multiple AWE lesions, offering a valuable tool for preoperative risk assessment.