Abstract 1. 1. Endometriosis is not uncommon. 2. 2. Symptoms depend upon the location of the endometrial deposits. 3. 3. History eliciting periodic symptomatology is of great importance in diagnosis. 4. 4. Lack of visual implants at the time of operation does not mean that endometriosis is not responsible for symptoms or pathology found. 5. 5. The general surgeon should be familiar with the diverse characteristics of endometriosis. 6. 6. A case is presented of perirectosigmoid endometriosis simulating carcinoma causing a rectal stricture, with endometrial deposit in the extra-peritoneal portion of the round ligament and an impacted fibroid uterus.