Multifocal extra pelvic endometriosis. A rare case report and literature review

Little known, but omnipresent, endometriosis is a gynecological pathology affecting nearly 10% of women of childbearing age. Of exact pathogenesis not yet clear, the entity is multifactorial and complex, defined by the histological development of endometrial tissue outside the uterine cavity, functionally similar to the eutopic endometrium, and which will undergo, during each menstrual cycle, the the influence of hormonal changes. The disease, long ignored, is a chronic, heterogeneous, inflammatory disorder, usually leading to chronic pain and impaired fertility. Although in most cases the ectopic implantation site is in the pelvis, it can affect different organ systems, taking on a range of different and non-uniform forms. Complex presentations, particularly multifocal, of the entity are a rare phenomenon, making its early diagnosis and management often difficult. Endometriosis governs one of the most puzzling and most important public health problem patterns not only from a medical and economic perspective, but also from a socio-professional perspective. In this report, we review a case of multifocal extra pelvic endometriosis which was difficult to diagnose, leading to delayed resolution. Our goal is to provide a resource regarding the variable presentations of the disease, to increase awareness and suspicion, while reviewing its management, based on the available evidence.