Because morbid obesity may confer a relative immunodeficiency, morbidly obese patients may develop unusual infections such as opportunistic fungal abscesses.

Introduction: Endometriosis is a common gynaecological condition, usually presenting with pelvic pain or infertility in women of reproductive age. Diagnosis is made on histopathology of deposits excised during laparoscopy, given diagnosis solely made by macroscopic examination can be challenging for even experienced gynaecological surgeons. Case description: A 45-year-old during laparoscopy for fibroids is found to have peritoneal deposits resembling endometriosis. Histopathology reveals multifocal metastatic grade 1 neuroendocrine tumour of the appendix. Conclusion: This incidental finding highlights the importance of thorough examination of the appendix and abdominal cavity for unexpected pathology during gynaecological laparoscopy. Incidental finding of appendiceal pathology at time of laparoscopy for endometriosis is not uncommon; however, the finding of metastatic malignancy is far rarer. While several case studies have reported severe endometriosis mimicking advanced stage cancer, this is the first documented occurrence of an advanced, metastatic tumour, mimicking endometriosis.

Background: The Endometriosis Phenome and Biobanking Harmonisation Project has been set up to facilitate and advance global endometriosis research. Aim: To test the feasibility and practicality of using the Endometriosis Phenome and Biobanking Harmonisation Project standard surgical form in routine clinical practice. Materials and methods: Standard surgical form was filled out using a web-based application for 225 consecutive women who underwent surgery for suspected or known endometriosis. Results: Median age was 37 years. Half (49.8%) of the women had a previous surgical diagnosis of endometriosis. Endometriosis was found in 91.5% of patients in this cohort. Median operative time was 101 min. Operative photographs substantially assisted completion of the standard surgical form post-operatively. The median time required to fill out the questionnaire was 8 min (range, 2-17 min). This was mostly dependent on the severity and distribution of endometriosis lesions. The standard surgical form is very comprehensive and has the advantage of including both the American Society of Reproductive Medicine classification and the Endometriosis Fertility Index; however, characterisation of deep endometriosis is insufficient for some women. In addition, some sections such as the descriptive endometriosis table (section IX) remain subjective. Conclusion: Using the Endometriosis Phenome and Biobanking Harmonisation Project standard surgical form to collect research data is feasible, especially when using an electronic database entry tool. It is also practically manageable, although the time taken is more than originally estimated by the Endometriosis Phenome and Biobanking Harmonisation Project standard surgical form authors. Even though some sections of the standard surgical form may be subjective, it is comprehensive and we would recommend its adoption into routine clinical practice for endometriosis research.

Introduction: Caesarean scar defect is a well-recognised complication of caesarean section. It can cause secondary infertility, although the mechanism is still poorly understood. Case description: We present the case of a patient diagnosed with a caesarean scar defect on transvaginal ultrasound, following referral for secondary infertility. During laparoscopy performed with concurrent hysteroscopy, the caesarean scar defect was found to be continuous with an endometriotic nodule in the uterovesical peritoneum. This was excised along with other endometriosis implants. Histopathology of the resected defect also showed endometriosis. Conclusions: This case illustrates a possible link between caesarean scar defect and endometriosis, and highlights the benefit of laparoscopy to allow additional treatment of coexisting pathology, such as endometriosis, that could also contribute to infertility.