Endometriosis is the presence of endometrial tissue outside of the uterine cavity. Scar endometriosis (SE), a rare occurrence, results from inadvertent extrapelvic transplantation of endometrial tissue to an incision site, such as from a low transverse cesarean section (LTCS). The reported incidence of abdominal wall scar endometriosis status-post cesarean section is 0.03 - 0.6%. We present a case of rectus abdominis scar endometriosis diagnosed four years following an LTCS. Our case report discusses the history/presentation, imaging findings, histopathology, and pertinent literature concerning abdominal wall scar endometriosis.