Evidence-based case report: How to deal with unpredicted endometriosis nodule closed to ureter and rectum during laparoscopy

Sigit Purbadi, Bella Aprilia, Lisa Novianti
International journal of surgery case reports · 2019 · vol. 61 , pp. 280–284 · doi:10.1016/j.ijscr.2019.07.012 · PMID:31401435 · PMC6699556 · W2962759462
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This case report details management of an unexpected deep infiltrating endometriosis nodule near the ureter and rectum during laparoscopy, emphasizing anatomical knowledge and experienced surgical handling.

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Abstract

INTRODUCTION: Endometriosis is characterized by the growth of endometrial-like tissue within and outside the pelvic cavity. Peritoneum nodules invaded more than 5 mm representing the commonest form of deep infiltrating endometriosis nodules might challenge inexperienced operator due to its location near ureter and the rectum. The aim is to provide important steps on how to deal with unexpected peritoneal endometrial nodules located closed to ureter and rectum. PRESENTATION OF CASE: A 43-year-old female underwent laparoscopic cystectomy after being diagnosed to have right endometriosis cyst. The researchers found multiple endometriosis nodules located closed to rectum and ureter after performing cystectomy. A search was conducted on PubMed® with the keywords of "Peritoneal endometriosis nodule" AND "rectovaginal endometriosis nodule" AND "Surgical ablation" OR "Surgical excision" AND "Laparoscopy" AND "Pelvic pain". Reference lists of relevant articles were searched for other possible relevant studies. After selecting the articles, the critical review was performed based on a standardized appraisal form for the treatment study. DISCUSSION: Three eligible studies were appraised to assess the surgery outcome (dyspareunia), based on ablation and excision criteria. The pain was decreased during 6 months of follow up, with no difference in both techniques. The minimal requirement to remove the posterior nodules is knowledge of pelvic retroperitoneal anatomy. CONCLUSION: In all endometriosis cases which require surgery will need to be performed by an experienced operator. If rectovaginal endometriosis nodule was unexpectedly found during intraoperative and recognition of rectum and ureter must be done, knowledge of retroperitoneal anatomy is required.

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Condition tags

endometriosisdie_deep_infiltratingbowel_endometriosisdyspareunia

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (27)

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escherichia coli

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License: CC0 · commercial use OK