Deep infiltrating endometriosis mimicking abdominopelvic tuberculosis in a premenopausal woman: a diagnostic challenge

Ruby Bhatia, Niyati Trivedi, Vidushi Tewari, Ashlesha Aryan
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2026 · vol. 15(9) , pp. 3696–3701 · doi:10.18203/2320-1770.ijrcog20263065 · W7204495990
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A 42-year-old woman with deep infiltrating endometriosis mimicking peritoneal tuberculosis underwent total hysterectomy with bilateral salpingo-oophorectomy, achieving significant symptomatic relief after diagnostic challenges obscured by overlapping clinical features.

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This case report describes a 42-year-old multiparous woman presenting with chronic pelvic pain, dyspareunia, and dyschezia who was initially suspected of having peritoneal tuberculosis due to overlapping clinical features such as dense pelvic adhesions and elevated inflammatory markers. Comprehensive diagnostic evaluation, including magnetic resonance imaging and specific tuberculosis workups, ultimately confirmed the diagnosis of deep infiltrating endometriosis rather than an infectious etiology. The patient underwent total hysterectomy with bilateral salpingo-oophorectomy, which resulted in significant symptomatic relief and uneventful postoperative recovery. This paper is centrally about endometriosis — specifically deep infiltrating endometriosis mimicking tuberculosis.

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Abstract

Deep infiltrating endometriosis (DIE) is the most severe form of endometriosis and is characterized by infiltration of pelvic structures beyond the peritoneal surface. Its presentation may occasionally mimic other chronic inflammatory conditions, particularly peritoneal tuberculosis, posing a significant diagnostic challenge in tuberculosis-endemic regions. The coexistence of haemorrhagic peritoneal fluid, dense pelvic adhesions, adnexal masses, and elevated inflammatory markers can obscure the diagnosis and delay definitive management. A 42-year-old multiparous woman presented with chronic pelvic pain, dyspareunia, and dyschezia. On per-vaginal examination, the cervix was found to be pulled upwards and was associated with marked cervical motion tenderness. Comprehensive clinical and radiological evaluation was performed. Magnetic resonance imaging (MRI) findings were suggestive of deep infiltrating endometriosis. A tuberculosis workup was also carried out to exclude genital/ peritoneal tuberculosis. Following thorough evaluation, the patient underwent definitive surgical management in the form of total hysterectomy with bilateral salpingo-oophorectomy. The postoperative course was uneventful, and the patient experienced significant symptomatic relief following surgery.
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Deep infiltrating endometriosis mimicking abdominopelvic tuberculosis in a premenopausal woman: a diagnostic challenge DOI: https://doi.org/10.18203/2320-1770.ijrcog20263065Keywords: Deep infiltrating endometriosis, Dyschezia, Peritoneal tuberculosis, Peritoneal fluid, Pelvic adhesions, Hydrosalpinx, Diagnostic dilemmaAbstract Deep infiltrating endometriosis (DIE) is the most severe form of endometriosis and is characterized by infiltration of pelvic structures beyond the peritoneal surface. Its presentation may occasionally mimic other chronic inflammatory conditions, particularly peritoneal tuberculosis, posing a significant diagnostic challenge in tuberculosis-endemic regions. The coexistence of haemorrhagic peritoneal fluid, dense pelvic adhesions, adnexal masses, and elevated inflammatory markers can obscure the diagnosis and delay definitive management. A 42-year-old multiparous woman presented with chronic pelvic pain, dyspareunia, and dyschezia. On per-vaginal examination, the cervix was found to be pulled upwards and was associated with marked cervical motion tenderness. Comprehensive clinical and radiological evaluation was performed. Magnetic resonance imaging (MRI) findings were suggestive of deep infiltrating endometriosis. A tuberculosis workup was also carried out to exclude genital/ peritoneal tuberculosis. Following thorough evaluation, the patient underwent definitive surgical management in the form of total hysterectomy with bilateral salpingo-oophorectomy. The postoperative course was uneventful, and the patient experienced significant symptomatic relief following surgery. Metrics References Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med. 2020 Mar 26;382(13):1244-56. DOI: https://doi.org/10.1056/NEJMra1810764 Giudice LC. Endometriosis. N Engl J Med. 2010;362(25):2389-98. DOI: https://doi.org/10.1056/NEJMcp1000274 Chapron C, Marcellin L, Borghese B, Santulli P. Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol. 2019;15(11):666-82. DOI: https://doi.org/10.1038/s41574-019-0245-z Johnson NP, Hummelshoj L, Adamson GD, Keckstein J, Taylor HS, Abrao MS, Bush D et al. World Endometriosis Society Sao Paulo Consortium. World Endometriosis Society consensus on the classification of endometriosis. Hum Reprod. 2017;32(2):315-24. DOI: https://doi.org/10.1093/humrep/dew293 Bazot M, Daraï E. Role of transvaginal sonography and magnetic resonance imaging in the diagnosis of uterine adenomyosis. Fertil Steril. 2018;109(3):389-97. DOI: https://doi.org/10.1016/j.fertnstert.2018.01.024 Sharma JB. Current Diagnosis and Management of Female Genital Tuberculosis. J Obstet Gynaecol India. 2015;65(6):362-71. DOI: https://doi.org/10.1007/s13224-015-0780-z Sharma JB, Sharma E, Sharma S, Dharmendra S. Female genital tuberculosis: Revisited. Indian J Med Res. 2018;148(Suppl): S71-S83. DOI: https://doi.org/10.4103/ijmr.IJMR_648_18 Gungor T, Kanat-Pektas M, Ozat M, Zayifoglu Karaca M. A systematic review: endometriosis presenting with ascites. Arch Gynecol Obstet. 2011;283(3):513-8. DOI: https://doi.org/10.1007/s00404-010-1664-1 Ferrero S, Camerini G, Ragni N, Venturini PL, Remorgida V. Endometriosis and bowel involvement: a review. Eur J Obstet Gynecol Reprod Biol. 2009;143(1):3-7. DOI: https://doi.org/10.1016/j.ejogrb.2003.10.020 Harada T, Taniguchi F. Deep infiltrating endometriosis: pathogenesis, diagnosis and management. J Obstet Gynaecol Res. 2023;49(1):45-56. Singh N, Sumana G, Mittal S. Pelvic tuberculosis versus advanced endometriosis: a diagnostic dilemma. J Obstet Gynaecol India. 2013;63(5):339-42. Nezhat C, Li A, Falik R, Copeland D, Razavi G, Shakib A. Bowel endometriosis: diagnosis and management. Am J Obstet Gynecol. 2018;218(6):549-62. DOI: https://doi.org/10.1016/j.ajog.2017.09.023

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