Laparoscopic resection of giant endometriotic cysts with mesenteric implantation

Laparoscopic resection of giant endometriotic cysts with mesenteric implantation DOI: https://doi.org/10.18203/2349-2902.isj20182786Keywords: Endometriosis, Giant endometriotic cyst, Laparoscopic resection, Mesentery, Mesenteric cystic tumorAbstract ndometriosis is defined as the presence of tissue which is histologically similar to the endometrium in locations outside the uterus. It affects women of reproductive age mainly and represents one of the main causes for hysterectomy and infertility amongst women. It has a broad spectrum of symptoms which make for a challenging diagnosis. Extragenital endometriosis affects up to 37% of all patients, and intestinal endometriosis has been observed in up to 12% of women affected by the disease, mainly involving the recto-sigmoid colon, ileocecal region and cecal appendix. Intestinal symptoms such as changes in depositional rhythm, diarrhoea and constipation are frequent and can evolve to acute abdominal obstruction in advanced stages of the disease. Authors present the case of a 51-year-old female that presented to the emergency room with abdominal, colic type, diffuse pain in the left flank, early satiety and postprandial fullness, CT scan revealed the presence of a lobed and septate mesenteric cystic tumor, of approximately 15.5 cm in diameter. Serum oncological markers were found to be within normal parameters. The patient underwent laparoscopic resection of the tumor with trans-operatory study, which ruled malignancy out and confirmed the presence of endometriotic tissue. The patient was discharged 72 hrs after surgery and prescribed anastrozole 1 mg orally every 24 hours. Follow up with Abdominal CT scan was performed 6 and 18 months later, showing no evidence of recurrence; the patient remains asymptomatic 18 months after surgery. Metrics References Fernández Parra J, Ruíz León M, Rodríguez Oliver A, et al. Diagnosis and classification of endometriosis. Act Obst Gin. 2008; 152:101. Burney R, Giudice L. Pathogenesis and Pathophysiology of Endometriosis. Fertil Steril. 2012; 98:3. Bianchi A, Pulido L, Espín F, Hidalgo LA, Heredia A, Fantova MJ. Endometriosis intestinal. Estado actual. Cirugia Espanola. 2007 Apr 1;81(4):170-6. Acar T, Acar N, Çelik SC, Ekinci N, Tarcan E, Çapkınoğlu E. Endometriosis within the sigmoid colon/extragenital endometriosis. Turkish J Surgery/ Ulusal Cerrahi Dergisi. 2015;31(4):250. Scioscia M, Ceccaroni M, Gentile I, Rossini R, Clarizia R, Brunelli D, et al. Randomized Trial on Fast Track Care in Colorectal Surgery for Deep Infiltrating Endometriosis. J Minimally Invasive Gynecol. 2017 Jul 1;24(5):815-21. Torralba-Morón A, Urbanowicz M, Ibarrola-De Andres C, Lopez-Alonso G, Colina-Ruizdelgado F, Guerra-Vales JM et.al. Acute Small Bowel Obstruction and Small Bowel Perforation as a Clinical Debut of Intestinal Endometriosis: A Report of Four Cases and Review of the Literature. Intern Med. 2016; 55: 2595-9. Haas D, Chvatal R, Habelsberger A, Wurm P, Schimetta W, Oppelt P, et.al. Comparison of revised American Fertility Society and ENZIAN staging: a critical evaluation of classifications of endometriosis on the basis of our patient population. Fertil Steril. 2011;95(5):1574-8. Haas D, Shebl O, Shamiyeh A, Oppelt P, et.al. The rASRM score and the Enzian lassification for endometriosis: their strengths and weaknesses. Acta Obstet Gynecol Scand. 2013; 92:3-7 Goenkaa L, Georgea M, Senb M. Peek into the drug development scenario of endometriosis – A systematic review. Biomed Pharma. 2017; 90 575-85. Słopień R, Męczekalski B. Aromatase inhibitors in the treatment of endometriosis Menopause Rev. 2016; 15(1): 43-7. Altintas D, Kokcu A, Kandemir B, Tosun M, Cetinkaya MB. Comparison of the effects of raloxifene and anastrozole on experimental endometriosis. Eur J Obst Gynecol Rep Bio. 2010; 150: 84-7. Kolahdouz R, Arablou T. Resveratrol and endometriosis: In vitro and animal studies and underlying mechanisms (Review) Biomed Pharma 2017; 91 220-8. Luu TH, Uy-Kroh MJ. New Developments in Surgery for Endometriosis and Pelvic Pain.Clin Obstet Gynecol. 2017; 60(2):245-251. Scioscia M, Ceccaroni M, Gentile I, Rossini R, Clarizia R, Brunelli D, et.al. Randomized trial on fast track care in colorectal surgery for deep infiltrating endometriosis, J Minim Invasive Gynecol. 2017; S1553-4650(17)30258-3. Roman H. A national snapshot of the surgical management of deep infiltrating endometriosis of the rectum and colon in France in 2015: A multicenter series of 1135 cases. J Gynecol Obstet Hum Reprod. 2017;46(2):159-165.