{"paper_id":"ea5213c1-0b52-44ff-8f26-26cf375c99ef","body_text":"J Obstetrics Gynecology and Reproductive Sciences                                                                                                                                                    Copy rights@ Feras Sendy \n \n \n \nAuctores Publishing – Volume 4(1)-040 www.auctoresonline.org  \nISSN: 2578-8965   Page 1 of 2 \n \n \nLaparoscopic Diagnosis and Treatment of Stage 4 Endometriosis after Traumatic Agni karma \nwith Abdominal Scars: a Case Report. \nFeras Sendy 1,   Wd Sendy2, Sameer Sendy 3 \n1Obstetrics and Gynecology Department, King Fahad Medical City, Riyadh, SaudiArabia. \n2King Abdullah University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia. \n3King Saud University, KSA \n*Corresponding Author: Feras Sendy. 1Obstetrics and Gynecology Department, King Fahad Medical City, Riyadh, SaudiArabia. \nReceived Date: April 20, 2019; Accepted Date: May 28, 2020; Published Date: June 11, 2020. \nCitation: Sendy F, Sendy W, Sendy S. (2020) Laparoscopic Diagnosis and Treatment of Stage 4 endometriosis After Traumatic Agni karma with \nAbdominal Scars: a Case Report.: Observational study. Obstetrics Genecology and Reproductive Sciences, 4(1):DOI:10.31579/2578-8965/040 \nCopyright: © 2020. Feras Sendy. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which \npermits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. \nAbstract  \nAgni karma refers to the use of heated metals by tra ditional physicians. Endometriosis is defined as implantation of \nendometrial cells outside the endometrial cavity. Presenting symptoms are dyspareunia and dysmenorrhea. Recognition and \nawareness of such disorder are vital to avoid skin damage. A 31 years old nulliparous presented with dysmenorrhea and \ndyspareunia after unsuccessful attempts to alleviate symptoms by heated metals. Stage 4 endometrioses was diagnosed via \nlaparoscopy and bilateral ovarian cystectomy was done for endometriomas. Agni karma is an unacceptable treatment for \nendometriosis as it results in avoidable body damage.  Using heated rods is contraindicated in endometriosis, as it does neither \nalleviate symptoms nor treat the condition. It is used due to its lower cost, rapidity to treat the  illness and non -complex \nequipment. To prevent unnecessary body damages, awareness is crucial along with consulting legal healthcare centers where \nmedical and surgical treatment from qualified healthcare professionals is provided. \nKeywords: endometriosis; agni karma; laparoscopy; dysmenorrhea and dyspareunia   \n \nIntroduction \nEndometriosis is a painful gynecological disorder, which occurs when \ntissues that resemble the normal endometrium grows outside the \nuterus(1). The disease affects several parts of the female reproductive \nsystem, including ovaries, fallopian tubes, and the pelvic lining. \nSometimes the disease may spread to organs outside. In severe cases, the \nendometrial tissue swells and breaks resulting in bleeding (1). This is \nusually accompanied by severe pain. To stop the progress of \nendometriosis, immediate treatment is requi red. Although medical \ntreatment can be used to relieve pain and arrest bleeding, getting rid of the \nendometrial tissues requires invasive procedures such as laparoscopy. \nHowever, in some parts of the world such as Saudi Arabia, Yemen and \nIndia, therapeutic heat burns, which involve heating the symptomatic site \nwith a hot metal are used to treat such diseases. According to the current \nmedical guidelines, such procedures are unacceptable, and they should \nnot be used in treatment. As such, this paper presents the first case report \nof a patient with endometriosis that experienced traumatic effects of \ntherapeutic heat burns that ultimately led to seeking medical advice for \ndiagnosis and treatment. The aims to discuss the reasons why therapeutic \nheat burns are unacceptable and increase awareness in order to diagnose \npatients with endometriosis. \nCase presentation \nA 31 years old nulliparous presented to our hospital with severe \ndysmenorrhea and dyspareunia for one year. The patient has a normal \nregular menstrual cycle with no inter-menstrual or post-coital bleeding. \nShe has used multiple herbal treatments that failed to alleviate symptoms. \nLastly, she went to a traditional public physician that used heated rods to \ncauterize her abdomen around a year ago. Figure 1 show s the traumatic \neffects of the patients’ skin due to the use of heated metals without \nalleviating symptoms.  \n \n \nFigure 1: Abdominal scarring from Agni karma. \n \nSexual activity was impaired with the husband due to dyspareunia and \nmultiple abdominal scars from the heated metals although, she had a \npregnancy desire. On examination, the abdomen was soft and lax, with no \napparent masses. Her Hemoglobin level was 11.6g/dl, CA 125 was \n  Open Access  \n     Case report \n   Journal of Obstetrics Gynecology and Reproductive Sciences \n                                                                                                                        Feras Sendy                                                                                                                                             \nAUCTORES \nGlobalize your   Research \n\nJ Obstetrics Gynecology and Reproductive Sciences                                                                                                                                                    Copy rights@ Feras Sendy \n \n \n \nAuctores Publishing – Volume 4(1)-040 www.auctoresonline.org  \nISSN: 2578-8965   Page 2 of 2 \n51.3U/mL and the blood group was O negative. Ultrasound assessment \nshowed an a nteverted uterus 3.8 x 3.8 x 4.2 cm with multiple uterine \nfibroids including: posterior intramural fibroid measuring 2.3 x 2 cm, \nanterior intramural fibroids 2.7 x 2.2 cm and 1.4 x 1.1 cm and right lateral \nintramural fibroids 1.7 x 1.7 cm and 1.0 x 0.9 cm.  The endometrial \nthickness was 0.5. The right and left ovaries had unilocular hypoechoic \ncyst suggestive of endometrioma measuring 4.1 x 3.1 cm and 5.1 x 3.5 \ncm, respectively. The patient was informed and consented for bilateral \nlaparoscopic ovarian cystec tomy. With Laparoscopy, we found a stage \nfour endometriosis according to the American fertility staging and \nlaparoscopic bilateral cystectomy was done without complications. \nHistopathology reports confirmed the diagnosis of endometriomas \nwithout malignancy. The patient was discharged on the same day, as the \npostoperative course was unremarkable. She was prescribed Dienogest \n(Visanne ®) after explanation in order to have medical and surgical \nbenefits. Follow up appointment showed improvement in \nsymptomatology with no dyspareunia. \nDiscussion \nAccording to Nagnath (2), therapeutic heat burns, commonly referred to \nas \"Agni karma\" in India is of much importance when applied carefully \nin healing wounds and other diseases involving tissues. Fir st of all, the \nchances of recurrence of the disease are low when this method is used. \nThe method involves heating of the bleeding site with a hot metal, which \ncauses coagulation resulting in total closure of bleeding vessels. \nSecondly, Agni karma ensures that every ill tissue is eradicated from the \nbleeding site. This removes all disease-causing microorganisms from the \nsite reducing chances of reoccurrence. Lastly, Nagnath (2) claims that the \ntherapeutic heat method is cheaper compare d to other surgical methods. \nThe procedure does not require complex equipment like other normal \nprocedures provided a specialist is summoned. It can be carried out at \nhome when medical treatment fails to bring positive results. \nAlthough this treatment allo ws quick healing of the bleeding site, it is \nassociated with many side effects and contraindications, which makes it \nunacceptable in current healthcare facilities. Firstly, the method involves \napplying hot equipment directly at the bleeding site. This can damage not \nonly the blood flow but also the skin alignment resulting in total damage \nto the patient's skin (3). Secondly, placing a hot object on the body directly \ncauses severe pain to the patient that can worsen their state instead of \ninducing healing. In that case, this method cannot be used to t reat young \nchildren or people who fear pain. Lastly, heat from the hot object may \ncause damage to organs near the bleeding site. Apart from the possible \nside effects of Agni karma mentioned above, the method is associated \nwith many contraindications, which  makes it unacceptable in hospitals. \nFor instance, it cannot be used in patients with thin skin since the heat \nmay affect the bone (3). Also, it is not applicable in patients with bleeding \ndisorders and those who are pregnant. Lastly, it cannot treat internal \nbleeding. \n Following this, medical agenc ies have rejected Agni karma as a \ntherapeutic procedure as it could not be of much importance due to its side \neffects and contraindications. Since endometriosis affects organs in the \npelvis, using Agni karma will only cause injury to the anterior parts of the \nskin and will never result in alleviating symptoms, neither  curing the \ndisease such as our patient. In this case, legal surgical procedures are \nrequired to treat endometriosis. The two major types of surgery involving \norgans in the uterus include conse rvative surgery and hysterectomy. \nConservative surgery consists of procedures such as laparoscopy, which \nis the use of a laparoscope to examine and remove endometrial tissues in \nthe uterus (4). Hysterectomy involves surgical removal of the w hole \nuterus in case of severe endometriosis. Unlike Agni karma, these \nprocedures are done under a specific procedure. The patient has to sign a \nwritten consent first to ascertain that she is ready for any outcomes. Also, \nthe procedures are done under general anesthesia, meaning that the patient \nwill not go through pain (5). Lastly, surgical procedures are performed by \nqualified physicians who are assisted by other healthcare professionals; \nhence, mistakes made can be corrected before they lead to adverse \noutcomes. \nFollowing the discussion above, it is clear that endometriosis can be better \ntreated surgically in legal healthcare facilities. Such facilities are well -\nequipped wit h surgical equipment necessary for removing endometrial \ntissues. On the contrary, therapeutic heat burns are carried out by \ntraditional physicians who do not understand the anatomy and physiology \nof the body. As such, they are likely to make mistakes that can damage \nother organs of the body. Also, therapeutic heat burns have many side \neffects and contraindications, making them unfavorable for use in legal \nhealthcare facilities. To avoid unnecessary body damages, only qualified \nhealthcare physicians should d iagnose and treat patients with \nendometriosis. \nConclusion \nAgni karma should be avoided to prevent the constant side effects and \ncontraindications. Patients who have endometriosis should visit legal \nhealthcare centers where they can receive medical and surgical treatment \nfrom qualified healthcare professionals. \nCompeting interests \nThe author(s) declare no competing interest concerning the research, \nauthorship, and publication of this article. \nConsent \nWritten informed consent was obtained from the patient for publication \nof this case report and accompanying images.  \nReferences \n1. Stovall DW. (2018). What Is New in Endometriosis?: Best \nArticles of the Past Year Obstet Gynecol. 132(4):1056-1058. \n2. Nagnath SR. (2019). A Critical Appraisal of Ancient Surgical \nInstruments. Research & Reviews:. Journal of Medical  Science \nand Technology. 2(1):10-14. \n3. Nakhate SR, Giri SV. (2017). Effect of Agnikarma in calcaneal \nspur: A case study. Ayurline: IJ-RIM. 1(02). \n4. Clark NV, Dmello M, Griffith KC, Gu X, Ajao MO, Cohen SL, et \nal. Laparoscopic treatment of endometriosis and predictors of \nmajor complications: a retrospective cohort study. Acta Obstet \nGynecol Scand. 2019. \n5. Ramirez PT, Frumovitz M, Pareja R, Lopez A, Vieira M, Ribeiro \nR, et al. (2018). Minimally invasive versus abdominal radical \nhysterectomy for cervical cancer. N Engl J Med. 379(20):1895 -\n904.","source_license":"CC0","license_restricted":false}