Abayomi Ajayi, Victor Ajayi, Ifeoluwa Oyetunji, Oluwafunmilola Biobaku, Happiness Aikhuele and Bamgboye M Afolabi
We report here the unusual presentation of a 35-year-old nulliparous Nigerian teacher who presented with a 5- year history of primary infertility, painful menses and cyclical umbilical bleeding. Evaluation revealed a clinically stable woman with a midline, infra-umbilical surgical abdominal scar near the site of bleeding, a large right hemothorax on Chest X-ray, kissing ovaries on pelvic scan and abdominal mass on CT scan. Prior to presentation she had been histologically diagnosed with endometriosis in 2014 by laparoscopy and biopsy after several tests to rule out other conditions like tuberculosis. She had chest tube drainage of 800 ml of brownish, chocolatecolored fluid, 2 doses of GnRH agonist injection and eventually occlusion of the pleural space due to recurrence of hemothorax.