The clinical features and management of perineal endometriosis with anal sphincter involvement: a clinical analysis of 31 cases

Na Chen, Lan Zhu, Jinghe Lang, Zhufeng Liu, Dawei Sun, Jinhua Leng, Qingbo Fan, Hui Zhang, Quancai Cui
Human Reproduction · 2012 · vol. 27(6) , pp. 1624–1627 · doi:10.1093/humrep/des067 · PMID:22422793 · W2108026890
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Abstract

BACKGROUND: The aim of this study was to investigate the appropriate measures for diagnosing and treating perineal endometriosis (PEM) with anal sphincter involvement. METHODS: Between January 1992 and April 2011, the clinical features, diagnosis and management of 31 patients who were diagnosed with PEM with anal sphincter involvement at the Peking Union Medical College Hospital were retrospectively analyzed using their clinical records. A range of 6-78 months of outpatient follow-up after surgery were conducted for these 31 patients but was extended by telephone interviews with 29 patients conducted in December 2011. RESULTS: All 31 patients had a history of vaginal delivery. The level of serum CA(125) was elevated in only 2 (6.5%) cases. All cases received surgical treatment, which included narrow excision (NE, close to the edge of the endometrioma) with primary sphincteroplasty (PSp) for 30 cases and incomplete excision (IE) for 1 case. Of the 30 cases in the NE group, 20 (66.7%) received hormone therapy preoperatively. Up until December 2011, there was one recurrence (3.6%) of PEM in the NE group. PEM relapse occurred in the IE patient 6 years after the initial IE surgery. Perineal abscesses were found in one patient post-operatively. No complaint of dyspareunia and no fecal incontinence episodes were observed during follow-up. CONCLUSIONS: Based on our own experience, NE and PSp may be indicated for the treatment of PEM with anal sphincter involvement.

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Condition tags

mesh:D004715endometriosisendometriomadyspareunia

MeSH descriptors

Anal Canal Endometriosis Endometriosis Perineum Adult Anal Canal Anal Canal Anal Canal CA-125 Antigen CA-125 Antigen Endometriosis Endometriosis Female Humans Perineum Perineum Perineum Postoperative Complications Postoperative Complications Pregnancy

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