Double Trouble: Resecting Endometriotic Nodules of the Bladder and Bowel and Creating an Omental J-Flap to Prevent Fistulas

Objective: Endometriosis may be found in the bladder and/or bowel. However, coexistence of deeply infiltrating endometriosis (DIE) in both bladder and bowel is relatively rare, with only a few documented cases . Simultaneous resection of both bladder and bowel endometriotic nodules increases the risk of fistula formation due to the proximity of multiple incision sites. Omental J-flaps have been effective for repairing and preventing fistulae in a wide variety of surgeries. Omental J-flap use after simultaneous resection of both bladder and rectal endometriotic nodules has not been described. This article, with narrated video footage, offers a stepwise demonstration of the technique used to create an omental J-flap to prevent fistula formation after hysterectomy and simultaneous resection of bladder and bowel endometriotic nodules Methods: The articles also offers an illustrative case of a 32-year-old female with chronic pelvic pain and abnormal uterine bleeding. She underwent total laparoscopic hysterectomy and bilateral salpingectomy followed by resection of 2 DIE bladder nodules and a DIE rectal nodule. These procedures were followed by creation of an omental J-flap to improve her surgical outcome. The J-flap was secured to her vaginal cuff to prevent formation of fistulas postoperatively due to the proximity of the surgical sites. Results: The patient was discharged on postoperative day 1 and fared well with no fistula formation the postoperatively. Pathology confirmed DIE of the bladder and rectum. Conclusions: An omental J-flap can prevent fistula formation after hysterectomy and simultaneous resection of bladder and bowel DIE nodules. (J GYNECOL SURG 39:246)