A case of chronic pelvic pain with extensive neural tissue in the lesion diagnosed as deep endometriosis using laparoscopy

Tomoko Tanaka, Shinichi Hoshi, Yuuko Kosako, Aya Masunaga, Takashi Hara, Megumi Shibata, Shouichi Watanabe, Shigeo Akira
In: JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY · 2023 · vol. 39(1) , pp. 85–91 · doi:10.5180/jsgoe.39.1_85 · W4386761042
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⚙ AI-generated summary by claude@2026-06, 2026-06-09 ⓘ

A laparoscopy identified deep endometriosis with extensive neural tissue in a patient with chronic pelvic pain, and surgical removal nearly resolved her symptoms.

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Abstract

The severe pain and discomfort of deep endometriosis are caused not only by local inflammation-associated peripheral neuralgia, but also by pain modulation of the central nervous system due to reflex contraction of pelvic organs responding to slight stimuli, correlates with the density of nerve fibers in the lesion. A 46-year-old woman with severe chronic pelvic pain, low back pain, and gastrointestinal symptoms underwent laparoscopic surgery. Preoperative blood tests and imaging studies have not revealed the cause of her pain for 10 years. During the operation, adhesions in the rectovaginal space were systematically dissected for dyspareunia and defecation pain, and the sacral uterine ligament and peri uterine tissue were excised while preserving the inferior abdominal nerve for dysmenorrhea and back pain. Pathologically, a nodular lesion removed from the rectovaginal cavity was found to have endometrial glands, inflammatory cells, smooth muscle, and numerous nerve fibers, leading to the diagnosis of deep endometriosis. A nodular lesion of the right sacral uterine ligament and posterior wall of the uterus, which was removed as a cause of right lower back pain, revealed no endometrial glands but had numerous nerve fibers. Postoperatively, her pain was almost completely resolved. We were able to diagnose and treat an undiagnosed deep endometriosis with severe chronic pelvic pain by laparoscopic surgery. Pathological examination revealed extensive nerve fibers in addition to endometrial glands, suggesting that the severe chronic pain was associated with these extensive nerve fibers. We believe this case will serve as a reference for future treatment of deep endometriosis.

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Condition tags

endometriosischronic_pelvic_paindysmenorrheadyspareunia

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