Post-menopausal endometriosis with inferior vena cava invasion requiring surgical management

Post-menopausal endometriosis is rare after hysterectomy, and preliminary data support treatment with aromatase inhibitors (AIs). Sites for extrapelvic recurrent disease are wide-ranging; however, no previous case reports have described endometriosis invading the inferior vena cava. A 59-year-old woman status post hysterectomy and bilateral salpingo-oophorectomy for endometriosis developed a periaortic mass with ureteral obstruction. Computerized tomography-guided biopsy confirmed recurrent endometriosis and the lesion enlarged despite treatment with AIs. Vascular surgery, urology and gynecology were involved. The mass was resected surgically and pathology confirmed invasion of the inferior vena cava. Medical management with AIs can be attempted for extra-pelvic endometriosis status post hysterectomy; however, the efficacy in this setting is limited. Surgical management may be necessary for bulky or invasive disease.