Surgical resection of spinal dural arteriovenous fistula with micro-tubular retractors under CT guidance: cases report and literature review.

Endometriosis is a benign disorder characterized by abnormal growth of endometrial tissue outside the uterus (). It affects approximately 190 millions of reproductive age women globally (). Debilitating symptoms comprise dysmenorrhea, dyspareunia, and infertility (). While endometriosis frequently affects pelvis, it can rarely occur in extra-pelvic sites, which makes it a complex condition, difficult to diagnose and to treat (). Extra-pelvic endometriosis refers to a rare type of endometriosis, which occurs in distant sites from gynecological organs (). Despite its rarity, extra-pelvic endometriosis can involve clinically significant sites such as abdominal wall, diaphragm, gastrointestinal tract, and brain (, ). In this paper, we present a case of a patient with severe abdominal pain, deep dyspareunia, and right-sided shoulder pain. Laparoscopic exploration revealed, in addition to pelvic endometriosis, both diaphragmatic and abdominal wall endometriosis (AWE). Through this case, we also aim to highlight diagnostic and surgical challenges associated with extra-pelvic endometriosis. On November 11, 2024, a 32 year-old primiparous woman with an ongoing illness, sought medical attention after being seen by many physicians for incapacitating abdominal pain related to menstruation. The patient was married for 8 years and had 1 live birth from a spontaneous pregnancy, delivered by cesarean section 6 years ago. Menarche was at 15 years of age, with regular menstrual cycles every 28–30 days and a duration of 3 to 5 days. She had no personal history of endometriosis as well as no documented relevant family history of endometriosis or other diseases. Her chief complains were dysmenorrhea, with abdominal pain was reported with a maximum intensity of 10 out of 10 on the Numerical Rating Scale (NRS), coupled with deep dyspareunia, and vaginismus, as well as right-sided shoulder pain.