Deep Gluteal Pain Secondary to Pelvic Wall Endometriosis- A Case Report

Chronic pelvic pain is a common condition that affects up to 26% of patients according to a recent systematic review. The clinical history and presentation are widely variable. Diagnosis is difficult and often delayed.

A 44-year-old woman presented to the pain clinic with a 5-year history of unexplained deep left buttock pain. The pain symptoms initially suggested entrapment of the left pudendal nerve. A subsequent magnetic resonance imaging showed an abnormal mass in the left ischiorectal fossa. Further biopsy confirmed endometriosis of the lateral pelvic wall, a rarely reported finding. Her pain symptoms considerably improved 70% after initiating medical therapy.

The diagnosis of chronic pelvic pain can be difficult and often delayed. The presence of unexplained pain symptoms, with a cyclical pattern in a child-bearing age, should raise the suspicion toward endometriosis.