Rare and atypical presentations of endometriosis causing diagnostic dilemma and management challenges: an experience at a tertiary center

Vinod Kumar Dalal, Hrishikesh Magdum, Manoj Kumar Tangri, Gunjan Malhotra, Ashisha
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2023 · vol. 13(1) , pp. 156–159 · doi:10.18203/2320-1770.ijrcog20233822 · W4389344076
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This case series describes unusual endometriosis presentations encountered at a tertiary center, highlighting diagnostic dilemmas and management challenges and emphasizing its consideration in atypical pelvic pain presentations.

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This case series from a tertiary center examines rare and atypical presentations of endometriosis that create significant diagnostic dilemmas and management challenges. The authors highlight instances where the disease presents with unexpected symptoms, such as massive hemoperitoneum or adnexal masses mimicking other acute conditions, leading to potential misdiagnosis during initial evaluations. They emphasize that clinicians must maintain endometriosis as a primary differential diagnosis for patients presenting with acute pelvic pain and complex imaging findings that do not fit standard clinical patterns. This paper is centrally about endometriosis — specifically focusing on unusual clinical manifestations and the resulting difficulties in accurate diagnosis and subsequent patient care.

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Abstract

Endometriosis is a disease that most of the times is diagnosed by its common presenting sign and symptoms, but can have varied presentations and may come as a surprise during surgery. We here present a case series of unusual presentations of endometriosis, which created diagnostic dilemma and challenges in the management of the cases at this tertiary center and share our experience. Endometriosis must be kept as a differential diagnosis whenever patient presents with acute pelvic or abdominal pain with adnexal masses and things are not fitting into straight forward diagnosis.
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Rare and atypical presentations of endometriosis causing diagnostic dilemma and management challenges: an experience at a tertiary center DOI: https://doi.org/10.18203/2320-1770.ijrcog20233822Keywords: Endometriosis, Infertility, Atypical, Massive hemoperitoneum, Adnexal massAbstract Endometriosis is a disease that most of the times is diagnosed by its common presenting sign and symptoms, but can have varied presentations and may come as a surprise during surgery. We here present a case series of unusual presentations of endometriosis, which created diagnostic dilemma and challenges in the management of the cases at this tertiary center and share our experience. Endometriosis must be kept as a differential diagnosis whenever patient presents with acute pelvic or abdominal pain with adnexal masses and things are not fitting into straight forward diagnosis. Metrics References Won S, Cho YJ, Lee N, Kim M, Kim MK, Jung YW, Yun BS et al. Atypical endometriosis is related to a higher recurrence rate. Eur J Obstetr Gynecol Reproduct Biol. 2020;254:44-51. Togami S, Kobayashi H, Haruyama M, Orita Y, Kamio M, Douchi T. A very rare case of endometriosis presenting with massive hemoperitoneum. J Minimally Invasive Gynecol. 2015;S1553-4650(15)00241-1. Kim BH, Park SN, Kim BR. Endometriosis-induced massive hemoperitoneum misdiagnosed as ruptured ectopic pregnancy: a case. J Med Case Rep. 2020;14(1):160. Bennett GL, Slywotzky CM, Cantera M, Hecht EM. Unusual manifestations and complications of endometriosis-spectrum of imaging findings: pictorial review. AJR Am J Roentgenol. 2010;194(6):WS34-46. Gao Y, Qu P, Zhou Y, Ding W. Risk factors for the development of tubo-ovarian abscesses in women with ovarian endometriosis: a retrospective matched case–control study. BMC Women’s Health. 2021;21:43. Khan KN, Akira F, Koichi H, Michio K, Masahiro N, Shinji F et al. Bacterial contamination hypothesis: a new concept in endometriosis. Reprod Med Biol. 2018;17(2):125-33. Obajimi G and Awolude O. Endometriotic ascites: A very rare presentation of pelvic endometriosis Ann Ibd. Pg. Med. 2019;17(2):190-92. Sampson J. Endometrial carcinoma of the ovary arising in endometrial tissue in that organ. Arch Surg. 1925;10:1-72. Taniguchi F. New knowledge and insights about the malignant transformation of endometriosis. J Obstet Gynaecol Res. 2017;43(7):1093-100. Kobayashi H. Screening, epidemiology, molecular biology, and treatment strategies for endometriosis-associated ovarian cancer. Reprod Med Biol. 2010;9(1):17-22. Kurman RJ, Shih IM. The dualistic model of ovarian carcinogenesis: revisited, revised, and expanded. Am J Pathol. 2016;186(4):733-47.

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