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Ectopic endometrial tissues are rarely observed on the serosal surfaces of bowel and laparotomy incisions, in the lungs,
bones and in the urinary tract. A few case reports of endometriosis in the retroperitoneal location has been reported in the
English literature. Endometriotic cyst in a retroperitoneal location mimicking a retroperitoneal tumor through the mesentery
of sigmoid colon is an extremely rare presentation. A 45 year old woman presented with pain abdomen of 3 months duration.
CT abdomen & pelvis revealed a retroperitoneal mass adjacent to left psoas and left ureter. On laporotomy, a cystic mass was
found in the retroperitoneum over the left common iliac vessels. The mass was excised in to preserving the left ureter, left
iliac vessels and sigmoid colon. The final histopathology revealed an endometriotic cyst. Recto-sigmoid junction is the most
common site of extra-genital endometriosis, with less frequent sites being the rectovaginal septum, small intestine, cecum and
appendix. Retroperitoneal presentation of endometriotic cyst is a rare presentation and only few cases have been reported.
Retroperitoneal endometriotic cyst may mimic a retroperitoneal tumor in view of the location. Retroperitoneal endometriotic
cyst in the sigmoid mesentery is an extremely rare presentation. Whenever a CT guided biopsy was not diagnostic in a
retroperitoneal lesion, complete excision is the treatment of choice to arrive at a final diagnosis.