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A 30-year-old female with a history of multiple cesarean sections presents to the emergency department with several months of right lower quadrant abdominal pain only associated with her menstrual cycles. CT abdomen and pelvis with contrast was remarkable for an abdominal wall mass that likely represented an endometrioma, and she was subsequently discharged with pain medications and conservative treatment. However, three months later, she returned to the ED, because her pain was unbearable and refractory to medical management. Interven