Vexing Fringes of Endometriosis: A Case Series

Endometriosis is a chronic, inflammatory, and progressive disease.Endometriosis can be pelvic, involving the uterus and ovaries, or extrapelvic, involving the lung, bowel, etc.The common presentation of endometriosis is with symptoms of congestive dysmenorrhea, dyschezia, deep dyspareunia, chronic pelvic pain, or infertility.Extrapelvic endometriosis is more challenging in terms of diagnosis and management.Abdominal wall endometriosis and thoracic endometriosis are more prevalent among extrapelvic endometriosis.The gold standard for diagnosis remains laparoscopy.In recent years, diagnosis has also been aided by imaging studies like magnetic resonance imaging (MRI) and surgical exploration with visualization of lesions, followed by histologic confirmation.In patients with pulmonary endometriosis, bronchoscopy and high-resolution computed tomography (CT) scan of the lungs can aid in diagnosis.Bowel endometriosis can mimic inflammatory bowel disease with nonspecific symptoms.Hemorrhagic ascites because of endometriosis poses a great diagnostic dilemma due to the various causes mimicking the condition.Here, we present a series of four cases with endometriosis with diagnostic difficulty and management.Many need a multidisciplinary approach and management at a tertiary care center.Medical management needs to be continued for suppression of the overall disease and relief of symptoms.In advanced cases, surgical management has to be done with adequate preparation.