Laparoscopic Resection of Adrenal Endometriosis

Background: Extrapelvic endometriosis can occur in every organ system, with a prevalence of 8.9%. Case: A 38-year-old woman presented with a history of right, acute low-back pain. She was referred to a surgical department for treatment of a subhepatic cystic lesion that probably originated from her liver. Magnetic resonance imaging revealed a 4-cm cystic mass with a subhepatic localization. A directed percutaneous needle biopsy showed the presence of endometriosis. At laparoscopy, three independent endometriotic lesions were found; two on the peritoneum and one on the right adrenal gland. The patient was managed with surgical resection of the endometriosis lesion in the abdominal wall and resection of the endometrioid cyst on the upper region of her right adrenal gland. Results: At a follow-up examination 6 months after the procedure, this patient reported having no pain. Conclusions: While management of adrenal endometriosis remains a challenge, surgery should be considered in patients with persistent pain and/or without improvement with hormonal therapy. A less-invasive approach with subsequent less morbidity is recommended. Nodule resection should be the first option in cases when it is possible to resect the entire macroscopic disease. A multidisciplinary team consisting of a gynecologist, a general surgeon, and a radiologist enabled secure, less-invasive, and feasible management of adrenal endometriosis, contributing to the successful outcome of this clinical case. (J GYNECOL SURG 30:318)