Perineal endometriosis in episiotomy scar with anal sphincter involvement: report of two cases and review of the literature

Goran I Barisic, Goran Barišić, Zoran Krivokapić, Zoran V Krivokapic, Krivokapic ZV, Jovanovic DR, Dejan R. Jovanovic
International urogynecology journal and pelvic floor dysfunction · 2005 · vol. 17(6) , pp. 646–649 · doi:10.1007/s00192-005-0022-5 · PMID:16231117 · W2085353045
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⚙ AI-generated summary by gemini-2.5-flash-lite+body, 2026-06-14 ⓘ

Two cases of perineal endometriosis involving the anal sphincter are presented, demonstrating successful wide surgical excision and sphincter reconstruction with excellent functional outcomes.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 · read from full text ⓘ

This paper reports two cases of perineal endometriosis arising in an episiotomy scar with anal sphincter involvement and reviews the prior literature on similarly rare presentations. Diagnosis was suspected on clinical exam, anal manometry was performed in both cases, and endoanal ultrasound was performed in one case; histopathology confirmed endometriosis, and both patients underwent wide excision of the endometriotic mass including part of the external anal sphincter followed by sphincter reconstruction using different techniques. The authors report uneventful recoveries with excellent functional outcomes and full continence at 2 years for both patients, but the paper is limited by its small case number and reliance on literature synthesis rather than comparative study design. This paper is centrally about endometriosis — specifically perineal/anal sphincter–involving endometriosis in an episiotomy scar.

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Abstract

Perineal endometriosis with anal sphincter involvement is a rare occurrence with only nine cases reported so far. Two such cases are presented, and the literature is reviewed. In presented cases, diagnosis was suspected at clinical exam. Anal manometry was performed in both cases and endoanal ultrasound in one case. Wide surgical excision of endometriotic mass together with part of external anal sphincter was carried out in both cases. The procedure was followed by anal sphincter reconstruction in an "overlapping" fashion in the first and "apposition" technique in the second case. Histopathologic tests confirmed endometriosis. The recovery was uneventful in both cases with excellent functional results. Two years after the operation, patients are asymptomatic and fully continent. According to the literature and our own experience, wide excision of endometrioma with primary sphincteroplasty seems to be the best chance of cure with satisfactory functional results and should be recommended.
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Abstract

Perineal endometriosis with anal sphincter involvement is a rare occurrence with only nine cases reported so far. Two such cases are presented, and the literature is reviewed. In presented cases, diagnosis was suspected at clinical exam. Anal manometry was performed in both cases and endoanal ultrasound in one case. Wide surgical excision of endometriotic mass together with part of external anal sphincter was carried out in both cases. The procedure was followed by anal sphincter reconstruction in an “overlapping” fashion in the first and “apposition” technique in the second case. Histopathologic tests confirmed endometriosis. The recovery was uneventful in both cases with excellent functional results. Two years after the operation, patients are asymptomatic and fully continent. According to the literature and our own experience, wide excision of endometrioma with primary sphincteroplasty seems to be the best chance of cure with satisfactory functional results and should be recommended. Similar content being viewed by others

References

Punnonen R, Klemi PJ, Nikkanen V (1980) Postmenopausal endometriosis. Eur J Obstet Gynecol Reprod Biol 11:195–200 Henriksen E (1955) Endometriosis. Am J Surg 90:331–337 Ranney B (1971) Endometriosis. 3. Complete operations. Reasons, sequelae, treatment. Am J Obstet Gynecol 109:1137–1144 Schickele M (1923) Les pseudolipomes du ligament large. Bull Mem Soc Anat Paris 20:603–605 Sampson JA (1921) Perforating hemorrhagic (chocolate) cysts of the ovary: their importance and especially their relation to pelvic adenomas of endometrial type. Arch Surg 3:245 Beischer NO (1966) Endometriosis of an episiotomy scar cured by pregnancy. Obstet Gynecol 28:15–21 Heaps JM, Nieberg RK, Berek JS (1990) Malignant neoplasms arising in endometriosis. Obstet Gynecol 75:1023–1028 Dougherty LS, Hull T (2000) Perineal endometriosis with anal sphincter involvement: report of a case. Dis Colon Rectum 43:1157–1160 DeCherney AH, Pernall ML (1995) Current obstetric and gynecologic diagnosis and treatment. Appleton & Lang, Norwalk, pp 801–807 Speroff L, Glass RH, Kase NG (1994) Clinical gynecologic endocrinology and infertility, 5th ed. Williams & Wilkins, pp 853–865 Matigbay PM, Heppel J, Leslie KO (2001) Endometriosis-associated invasive adenocarcinoma involving the rectum in a postmenopausal female. Dis Colon Rectum 44:1530–1533 Kanellos I, Kelpis T, Zaraboukas T, Betsis D (2001) Perineal endometriosis in episiotomy scar with anal sphincter involvement. Tech Coloproctol 5:107–108 Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Barisic, G.I., Krivokapic, Z.V. & Jovanovic, D.R. Perineal endometriosis in episiotomy scar with anal sphincter involvement: report of two cases and review of the literature. Int Urogynecol J 17, 646–649 (2006). https://doi.org/10.1007/s00192-005-0022-5 Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00192-005-0022-5

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Condition tags

endometriosis

MeSH descriptors

Anal Canal Anal Canal Endometriosis Endometriosis Episiotomy Adult Anal Canal Anal Canal Endometriosis Endometriosis Episiotomy Female Humans Perineum Ultrasonography

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