BACKROUND: Abdominal wall endometrioma is a rare condition, which usually develops in surgical scar of a Cesarean section (C-section) or of a hysterectomy. Scar endometriosis is a misdiagnosed condition in general surgery, since it mim- ics other surgical conditions. Diagnosis is mainly based upon a high index of suspicion. AIM: The purpose of this study is to highlight the characteristics of this rare pathology and assess the diagnostic algo- rithm and therapeutic options. METHODS: The article is a case series and therefore no specific methods have been applicable. RESULTS: In the current study, we present a case series of seven cases with abdominal pain on the Pfannenstiel incision, treated in our department during a two years period, between 2014 and 2016, followed by a brief review of the literature. CONCLUSION: Scar endometriosis may be difficult to diagnose as it is an unfamiliar entity to general surgeons. This con- dition can be confused with other surgical conditions. Imaging methods, such as ultrasound or CT-scan should be used for differential diagnosis. The prevention of scar endometriosis may also be important. Surgical excision is the treatment of choice for scar endometriosis.