title: Synchronous rectovaginal, urinary bladder, and pulmonary endometriosis.
abstract: BACKGROUND
  Extragenital endometriosis is an uncommon condition that can affect almost any organ system and tissue in the human body. Disease involving multiple distant sites is extremely uncommon.
  
  
  METHODS
  We report a rare case of synchronous rectovaginal, urinary bladder, and pulmonary endometriosis. We performed a Medline literature search using keywords "endom etriosis," "recto vaginal," "pulmonary," "bladder," "ureteral," "bowel," "extrapelvic," and "extragenital" and were unable to find any prior case reports of such findings. A 31-year-old female presented with catamenial dysuria of 1-year duration, pleurisy associated with spontaneous pneumothoraces of 7 months' duration and a long-standing history of pelvic pain. A multispecialty team with experience in endoscopic techniques was assembled, consisting of a thoracic, a urologic, and a gynecologic surgeon. Video-assisted thoracoscopic surgery with fulguration of all visible pleural endometriosis and pleurodesis was performed, followed by laparoscopic segmental bladder wall endometrioma excision and resection of rectovaginal endometriosis. Twelve months after surgery and without additional hormonal treatment, the patient is symptom free.
  
  
  CONCLUSIONS
  Extragenital endometriosis may coexist in multiple sites. A high index of suspicion aids in the diagnosis. A multidisciplinary approach in a tertiary center, followed by appropriate surgical eradication of visible disease, can successfully treat endometriosis even in such extreme cases.
authors.affiliation: Center For Special Minimally Invasive Pelvic Surgery, Stanford University Medical Center, USA. ghilaris2001@yahoo.com
authors.forename: Georgios E
authors.initials: GE
authors.lastname: Hilaris
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Payne
authors.forename: Joelle
authors.initials: J
authors.lastname: Osias
authors.forename: Walter
authors.initials: W
authors.lastname: Cannon
authors.forename: Camran R
authors.initials: CR
authors.lastname: Nezhat
mesh_terms: D000328:Adult; D004715:Endometriosis / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000150:complications* / Q000175:diagnosis; D012002:Rectal Diseases / Q000150:complications* / Q000175:diagnosis; D001745:Urinary Bladder Diseases / Q000150:complications* / Q000175:diagnosis; D014623:Vaginal Diseases / Q000150:complications* / Q000175:diagnosis