for laparotomy and a colostomy was opened by resection from the recto-sigmoid region. In both ovaries, endometrioma of 5cm were observed, which had moved towards the Douglas pouch in the left ovary and widespread endometriotic foci were observed over the broad ligament attached to the Douglas pouch. A diagnosis of Grade 4 endometriosis was made [9]. As advanced stage endometriosis was determined in the patient, there was a history of endometrioma surgery and she was being followed up for pain, a total abdominal hysterectomy and bilateral oopherectomy were applied at the same session for definitive treatment. No problems were experienced in the postoperative period and the patient was discharged on the 7th day. The mass was causing a serosal adhesion and extending 3.5 x 3 x 3cm within the intestinal lumen at 25cm length and 10cm width. Microscopic images of the mass are shown in figures 1 and 2. The intestine was seen with transmural lumen involvement, showing frequent changes in the endometriotic tissue and atypical