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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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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⚙ AI-generated deep summary by claude@2026-07, 2026-07-09 · read from full text ⓘ

The paper is a 2023 case report describing a 46-year-old woman with 10 years of severe chronic pelvic pain, low back pain, and gastrointestinal symptoms in whom preoperative blood tests and imaging did not identify a cause. After laparoscopic surgery with systematic dissection of rectovaginal adhesions and excision of the sacral uterine ligament and periuterine tissue (while preserving the inferior abdominal nerve), pathology identified a nodular rectovaginal lesion containing endometrial glands, inflammatory cells, smooth muscle, and numerous nerve fibers, and a separate ligament/uterine posterior wall lesion with numerous nerve fibers but no endometrial glands. The authors report that her pain was almost completely resolved and interpret the extensive nerve fibers, alongside endometriosis pathology, as associated with the severe pain. This paper is centrally about endometriosis — it is a case report using laparoscopy and pathology to link deep endometriosis lesions with extensive neural tissue to chronic pelvic pain.

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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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症例報告 腹腔鏡検査により深部子宮内膜症と診断された神経組織を有する慢性骨盤痛の１例 2023 年 39 巻 1 号 p. 85-91 詳細 抄録 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. © 2023 日本産科婦人科内視鏡学会

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endometriosischronic_pelvic_paindysmenorrheadyspareunia

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