This manuscript presents a case of a 35-year-old nulligravida premenopausal woman who presented with acute abdominal pain due to pelvic congestion syndrome (PCS). PCS is characterized by multiple pathophysiological mechanisms and various clinical presentations. Our patient was nulliparous with no history of abdominal surgery. However, diagnostic laparoscopy revealed endometriosis lesions on the uterovesical fold. Reporting this unusual case, we focus on the presenting symptoms, the imaging findings, and the final approach by diagnostic laparoscopy.