Endometriosis at several sites, cyclic bowel symptoms, and the likelihood of the appendix being affected (original) (raw)

Anatomic distribution of endometriosis: A reappraisal based on series of 1101 patients

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2018

Objective: To reappraise the anatomic distribution of endometriosis lesions in cases with Superficial Implants (SI), Ovarian Endometrioma (OMA) and Deep Infiltrating Endometriosis (DIE). Materials and Methods: A prospective observational study was operated between January 1989 to June 2009. A total of 1333 consecutive patients with a laparoscopic diagnosis of endometriosis, were extracted from our database. Due to missing data or repeated operations, 232 patients were excluded from the study. Finally, 1101 patients who met the selected criteria were included in the present analysis.. Primary outcome of study was the anatomic location of endometriotic lesions. Secondary outcomes were laterality of lesions as well as location of adhesions. Results: Mean age of patients was 33.06 years (range 15-63 years) while the mean BMI was 21.5. The ovary was the most frequent site of endometriotic lesions (737 patients, 66.94%) followed by the utero-sacral ligaments (USL) (45.51%), the ovarian fossa (32.15%), the pouch of Douglas (29.52%) and the bladder (21.25%). Deep Infiltrating Endometriosis (DIE) was diagnosed in 159 patients (14.4%) with an increasing rate starting from the mid-nineties. The left side was predominant for all locations except fromr ovarian SI and fallopian tube, but for this latter location the number of cases was limited. 600 (54.4%) patients had adhesions wjth the adnexa being the most frequent site of location (47.4%). Conclusions: Ovary was the main site of endometriotic lesions followed by the utero sacral ligaments. Left side was predominant for all locations except for ovarian SI and fallopian tube. The diagnosis of DIE has constantly being increased since mid-nineties. The large cohort of patients included in the study has strengthened previous reported data.

Bowel endometriosis: a surgical red flag

International Journal of Reproduction, Contraception, Obstetrics and Gynecology

Endometriosis is a disease restricted usually to the female genital tract. Involvement of the bowel by this disease can lead to a diagnostic dilemma due to the great variation in the symptomatology. Awareness of the pathophysiology, clinical features and diagnostic modalities is of utmost importance to decide the modality of treatment. Hormonal manipulation and surgical resection are the two modalities of treatment. The choice depends upon critical analysis of clinical and radiological findings and the desire to have pregnancy in cases associated with infertility.

Clinical Pattern and Spectrum of Atypical Endometriosis: A Series of 5 Cases

International Journal of Innovative Research in Medical Science

Endometriosis refers to the extrauterine presence of hormonally active endometrial glands and stroma. This ectopic endometrial tissue exhibits cyclic bleeding, inflammation, fibrosis and leads to formation of adhesions. Endometriosis affects about 10% to 15% of women between 15 to 45 years of age. Clinical presentations vary from infertility, dysmenorrhoea, chronic pelvic pain, deep dyspareunia and even bleeding at external sites like the umbilicus. Besides involving fallopian tubes, bowel, liver, thorax, pericardium, pleura etc, the most commonly affected areas in the gastrointestinal tract are the descending colon, rectosigmoid, appendix, and ileo-caecum in descending order of frequency. This case series highlights some unusual presentations of endometriosis along with co-existence of other ovarian pathologies which are not frequently encountered in clinical practice. This series also highlights the role of preoperative radiology for an adequate clinical diagnosis and complete sur...

Intestinal endometriosis: Diagnostic ambiguities and surgical outcomes

World Journal of Clinical Cases, 2019

BACKGROUND Endometriosis is a common disease for women of reproductive age. However, when it involves intestines, it is difficult to diagnose preoperatively because its symptoms overlap with other diseases and the results of evaluations can be unspecific. Thus it is important to know the clinical characteristics of intestinal endometriosis and how to exactly diagnose. AIM To analyze patients in whom intestinal endometriosis was diagnosed after surgical treatments, and to evaluate the clinical characteristics of preoperatively misdiagnosed cases. METHODS We retrospectively reviewed the pathologic reports of 30 patients diagnosed as having intestinal endometriosis based on surgical specimens between January 2000 and December 2017. We reviewed their clinical characteristics and surgical outcomes. RESULTS Twenty-three (76.6%) patients showed symptoms associated with endometriosis, with dysmenorrhea being the most common (n = 9, 30.0%). Thirteen patients (43.3%) had a history of pelvic surgeries. Ten patients (33.3%) had a history of treatment for endometriosis. Only 4 patients (13.3%) had a diagnosis of endometriosis based on endoscopic biopsy findings. According to preoperative evaluations, 13 patients (43.3%) had an initial diagnosis of pelvic endometriosis and 17 patients (56.6%) were misdiagnosed as having other diseases. The most common misdiagnosis was submucosal tumor in the large intestine (n = 8, 26.7%),

Surgery for gastrointestinal endometriosis: indications and results

Acta chirurgica Belgica

Although gastrointestinal endometriosis is an uncommon and often unexpected finding, the best treatment requires removal of all endometriotic lesions. The purpose of our study was to report our experience with the diagnosis and treatment of bowel endometriosis. From January 1997 to January 2004, 13 patients (mean 35.7y ; range 21-55y) were operated for bowel endometriosis. We noted: age, history of endometriosis, previous pregnancies, preoperative investigations and symptoms, operative procedure and intraoperative findings. Follow-up varied between one month postoperative examination and seven years. Presenting symptoms of the cases were: acute appendicitis (3), dysmenorrhoea (7), constipation (6), pelvic pain (2), rectal bleeding (3) and dyspareunia (2). Operative management was performed in accordance with the anatomical distribution. Seven patients had a history of previous operations and multifocal involvement was present in 61.5% of cases. At a median follow-up of 12.2 months, ...

Endometriosis: A diagnostic merry-go-round: A case report

International Journal of clinical obstetrics and Gynecology, 2020

Endometriosis affects mainly menstruating women. We present a case of endometriosis complicated by a tortuous diagnostic course and intestinal obstruction in a 28 year old nulliparous woman who had three laparotomies on account of two wrong diagnosis in a resource limited setting.

Prevalence, Surgical, and Medical Management of Patients with Endometriosis amongst Indian Women

2023

Objective: This study aims to determine the prevalence of endometriosis in women in South India, the epidemiological factors involved, and evaluate the symptomatic burden associated with it. Design: A large-scale Hospital-based study was conducted among women of reproductive age (16 to 44 years) in the state of Telangana between March 2018 and March 2023. A randomized multi-stage stratified sampling method was adopted and included 2,400 women who were screened using a validated structured questionnaire. Patients presenting with symptoms indicative of endometriosis underwent additional assessment using abdominal ultrasonography (AUS) and serum cancer antigen 125 (CA125) tests. For confirmation, laparoscopy was offered to the patients who consented. Patients who declined laparoscopy were given the option of undergoing magnetic resonance imaging (MRI) instead. Results: Among 2,400 women who participated, 60 women have been diagnosed with endometriosis during the 5-year study period. The prevalence of endometriosis was found to be 2.5%. The mean age of participants was 15.2 ± 3.5 years and the mean age at menarche was found to be 12.9 ± 1.1 years. Out of 60 participants diagnosed with endometriosis 30% (n = 18) experienced irregular menstrual cycles. Approximately 33.3% (n = 20) of the women reported experiencing Dysmenorrhea, with 28.4% (n = 17) complaining of dyspareunia. Among the cases with menstrual pain, exhibited ultrasound findings suggestive of endometriosis, with elevated CA125 levels observed in 45% (n = 27) of these cases. All 60 patients who consented to laparoscopic confirmation, exhibited positive histo-pathological evidence of endometriosis. The prevalence of endometriosis is found to be significant in women of reproductive age group and found to be associated with high rates of infertility in 15 (25%) patients. The results of this study showed that the prevalence of endometriosis is found to be 2.5% which is similar to the other studies reported. The severity of endometriosis during laparoscopy was assessed using the rAFS staging system, revealing rates of 55% and 45% for disease in Stages I & II, Stages III, & IV, respectively. Conclusion: Our study concludes that endometriosis predominantly affects women in the reproductive age group and is often associated with primary infertility. The laparoscopic findings are identified as a standard tool for both diagnosis and treatment of endometriosis.

Two Cases of Acute Abdominal Intestinal Endometriosis

Journal of Emergency Medicine Case Reports, 2017

Endometriosis is a common gynecologic disease, with an estimated incidence of approximately 15% of all women of reproductive age (1). It is characterized by the presence of endometrial glands and stroma outside the uterine cavity and is usually found in the ovaries, rectovaginal pouch, and pelvic peritoneum. However, extrapelvic sites such as the lungs, urinary tract, and gastrointestinal system are less affected sites (2). The rectosigmoid junction, ileum, and appendix are the most commonly reported regions for intestinal endometriosis (IE) (3). Although IE is usually asymptomatic, it may be presented with acute abdomen findings. Here we present the cases of two IE patients who underwent emergency surgeries. Case Reports Case 1: A 65-year-old woman presented with abdominal pain and nausea for 24 h. She had a history of multiple cesarean sections and hysterectomy. On examination, defense and rebound tenderness were observed at the right lower quadrant of the abdomen. Inflammatory markers including white blood count (WBC) (15.5 K/μL) and c-reactive protein (CRP) (98.4 mg/L) were elevated. On ultrasonography (US), enlarged appendix with a small amount of fluid between the intestines was detected. During surgery, a hyperemic and enlarged appendix caused by a brownish mass in the middle part of the organ was found; therefore, a standard appendectomy was performed. The lesion was histopathologically diagnosed as appendicial endometriosis. The patient was discharged without any complication on the second postoperative day. No recurrence was observed during the follow-up period of 30 months. Case 2: A 35-year-old woman presented with abdominal pain, nausea, vomiting, and obstipation for 3 days. She had a history of cesarean section. Her menstruation was quite painful for the previous 2 years. She also suffered from crampy abdominal pain, especially during the menstrual cycle. On examination, the abdomen was distended, bowel sounds were increased, and rectum was empty. Laboratory ABSTRACT Introduction: Gastrointestinal endometriosis is an uncommon form of extragenital endometriosis. The ileum and appendix are the most affected sites following the rectosigmoid region. Case Report: Clinicopathological findings, diagnostic approaches, and therapeutic outcomes of two intestinal endometriosis patients who presented with acute abdomen findings were reviewed. Conclusion: Although intestinal endometriosis is often difficult to diagnose using imaging methods, cyclic symptomatology and a history of obstetric/gynecologic surgery should alert clinicians to consider this diagnosis. Surgery seems to be the best treatment option and mainly depends on the affected site and clinical presentation.