Endometriosis can present in a variety of ways and must be considered in women of reproductive age who have complaints of pelvic or abdominal origin. It can be a difficult diagnosis to make, and it can mask the signs and symptoms of various other disease processes. The condition leads to fibrosis and adhesion formation, and is a common cause of infertility and spontaneous abortion. This report highlights the clinical and pathologic findings in a woman with pelvic endometriosis and discusses current concepts in treatment.