Double trouble: pelvic pain associated with a dual presentation of endometriosis and granulomatous peritonitis

A 34-year-old patient presented to our office with chronic pelvic pain. Prior laparoscopic surgery revealed endometriotic appearing lesions which were ablated. The patient opted for another surgery to diagnose and treat potential leftover endometriosis. Laparoscopy revealed the presence of endometriotic appearing lesions, but pathology revealed two different histological diagnosis: endometriosis and granulomas, even in areas where no endometriosis was encountered. In any granulomatous presentation, exposure to mycobacteria must be ruled out. Without excision of abnormal appearing lesions seen on laparoscopy, endometriosis can not be confirmed and other potential causes of pain cannot be excluded.