Primary Infertility Associated with Abdominal Wall, Bowel, and Pelvic Endometriosis

Background: This is the first reported case, to our knowledge, of multifocal endometriosis associated with primary infertility, involving the abdominal wall, the bowel, and the pelvis. Case: A 38-year-old nulligravid female with no prior abdominopelvic surgical history and a history of primary infertility; central dysmenorrheal; dyspareunia; dyschezia associated with nausea, bloating, indigestion, and constipation; a right upper quadrant (RUQ) lump; and cyclic RUQ and periumbilical pain was evaluated with findings of a palpable RUQ mass of approximately 3 cm to the right of the umbilicus. A magnetic resonance imaging scan and ultrasonography revealed the presence of a mass consistent with an abdominal-wall endometrioma. Laparoscopy revealed multifocal endometriosis, including the areas of the right abdominal wall, ileum, appendix, cecum, perirectum, anterior rectum, periureter, bladder, distal vagina, and ovarian endometrioma. The patient underwent radical excision of all endometriosis identified, including the abdominal-wall endometrioma with mesh repair, bowel resection with anastomosis, and ovarian cystectomy. Results: The patient was discharged from the hospital on the 6th postoperative day uneventfully. Conclusions: Given that the diagnosis of subcutaneous endometriosis without any prior surgical procedures is rarely encountered, endometriosis should be included in the differential diagnosis of masses of the abdominal wall in patients reporting cyclic pain symptoms corresponding to menses and infertility. (J GYNECOL SURG 27:45)