Risk Factors, Clinical Symptoms, and Different Treatment Approaches on Extrapelvic Endometriosis: Case Series

Introduction: Extrapelvic endometriosis (EPE) is a rare manifestation of endometriosis occurring outside the pelvic cavity. This condition often presents with diverse and atypical symptoms, complicating both diagnosis and management. Aims: The aim of this case series is to describe the risk factors, clinical presentations and treatment strategies. Methods: A total of 16 patients with a history of cyclical pain at sites of prior abdominal surgery, who underwent surgical treatment that was later histologically confirmed as endometriosis, were included. Patient demographics, clinical features, management approaches and adjuvant therapies were reviewed. Surgical excision was tailored to lesion characteristics, and then postoperative hormonal suppression was administered when indicated. Results: The mean age of the subjects was 35.93 ± 6.64 years, and most had a history of caesarean section. Clinical symptoms predominantly included cyclical pain and palpable masses, with lesion distribution including 13 caesarean scar sites, 2 umbilical sites and 1 vulvar site. Surgical excision, using elliptical, circular, or direct approaches depending on lesion characteristics, was then followed by postoperative progestin therapy provided selectively. All patients experienced symptom resolution, and no recurrences were observed during follow-up, including patients managed with surgery alone. Conclusions: This case series highlights the clinical variability of EPE and emphasises the importance of thorough evaluation and a personalised management approach. Surgical excision proves effective for symptom relief, with adjuvant therapies addressing recurrence risks. Individualised management based on lesion characteristics and associated pelvic disease is recommended. Further research is essential to establish standardised management protocols for this rare and challenging condition.