Laparoscopic treatment of a complex adnexal mass of the retroperitoneal space: A case report

This paper is a case report describing a 45-year-old premenopausal multiparous woman with left abdominal and low back pain whose CT and MRI identified a complex 6–7 cm cystic lesion in the left parametrial/retroperitoneal space that appeared suspicious for malignancy; tumor markers were negative. Exploratory laparoscopy found a left ovarian endometrioma extending retroperitoneally, along with a few endometriosis foci in the pouch of Douglas, and the endometrioma was excised laparoscopically after careful detachment from the ureter and mesosigmoid, with histology confirming endometriosis. A key caveat is that diagnosis ultimately relied on invasive surgery and histopathology, and transvaginal ultrasound was omitted because of the initial CT/MRI workup. This paper is centrally about endometriosis — it highlights a retroperitoneal/parametrial endometrioma that mimicked a complex adnexal mass.

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