not-yet-known not-yet-known not-yet-known unknown 1 Key Clinical Message: Only around 0.03-0.4% of cesarean section surgeries develop Scar endometriosis which being rare can be a diagnostic challenge, often leading to frustration for both patients and healthcare providers. It is crucial for physicians to remain vigilant, especially when women report cyclical pain at incision sites following pelvic surgery. Comprehensive evaluation, including detailed medical history and physical examination, is essential. Surgeons should consistently consider scar endometriosis in their differential diagnosis to ensure timely and appropriate management. Ultrasonography (USG) and magnetic resonance imaging (MRI) are valuable diagnostic tools, and wide excision is the preferred treatment as pharmaceutical interventions may not provide sustained relief. 1 Key Clinical Message: