International Surgery Journal | August 2021 | Vol 8 | Issue 8 Page 2436 International Surgery Journal Mushtaq R et al. Int Surg J. 2021 Aug;8(8):2436-2453 http://www.ijsurgery.com pISSN 2349-3305 | eISSN 2349-2902 Case Report Extra-pelvic endometriosis presenting as recurrent hepatic cyst: case report and literature review Ruqia Mushtaq*, Aqsa Ameer, Muhammad Hanif, Fatima Rauf INTRODUCTION Endometriosis is a benign gynecological disorder first described in 1860. It is characterized by the presence of uterine endometrial tissue outside of normal location mainly on pelvic peritoneum, in ovaries and fallopian tubes. Endometriosis usually affects 5-10% of women of reproductive age out of which extra-pelvic type of endometriosis is extremely rare. Extra-pelvic endometriosis refers to the presence of ectopic endometrium in extra-pelvic locations such as lungs, pleura, kidneys, bladder, abdominal wall, umbilicus, and cesarean section scar among others. Gastrointestinal tract is the most common location of extra-pelvic endometriosis while urinary tract is the second one. Extra-pelvic endometriosis usually affects a slightly older population of women compared to pelvic endometriosis. 1 Involvement of almost every organ has been described except the spleen. 2 Hepatic endometriosis is an extremely rare form of extra-pelvic endometriosis. There is a very limited data available on hepatic form of extra-pelvic endometriosis and our review is an addition to the available data. This form of endometriosis presents as a diagnostic dilemma because the only form of definitive diagnosis is via postoperative histopathology of the tissue. The aim of the review was to highlight rare form of extra-pelvic endometriosis so that it is kept as a differential in any woman presenting with hepatic cystic lesion. A thorough review of the literature showed that till now only 42 cases of hepatic endometriosis have been discovered making our case the 43 rd case. CASE REPORT A 30-years-old multiparous woman presented with a one- month history of abdominal pain. Her past surgical history included an appendectomy performed at 12 years of age. At the age of 22 years, she got her first pregnancy, during ABSTRACT Hepatic endometriosis is a very rare form of endometriosis first described by Rokitansky in 1986. To our knowledge, 42 cases of hepatic endometriosis have been reported in the literature till date. The condition offers a diagnostic challenge owing to its variable presentation on imaging and the need for histological and immunohistochemical evidence for a definite diagnosis. We hereby present the 43 rd case of ectopic endometrium in the liver of a 30 years old, multiparous female who presented with fever and pain in the right hypochondrium. Radiological imaging suggested a cystic lesion which was managed laparoscopically. Histopathology and immunohistochemistry findings came out to be consistent with endometriosis. The case highlighted the importance of considering endometriosis as a differential in all women irrespective of age and previous history of endometriosis. Keywords: Endometriosis, Cyst, Hepatic endometriosis, Liver endometriosis, Case report Department of Surgery, Benazir Bhutto Hospital, Rawalpindi, Pakistan Received: 14 June 2021 Revised: 18 July 2021 Accepted: 21 July 2021 *Correspondence: Dr. Ruqia Mushtaq, E-mail: drruqiamushtaq@yahoo.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: https://dx.doi.org/10.18203/2349-2902.isj20213143