Sacral Nerve Infiltrative Endometriosis Presenting as Perimenstrual Right-sided Sciatica and Bladder Atonia: Case Report and Description of Surgical Technique

Nucelio Lemos, Lemos N, Kamergorodsky G, Gil Kamergorodsky, Christine Ploger, Ploger C, Christine Plöger, Rodrigo Castro, Rodrigo Aquino Castro, Schor E, Eduardo Schor, Manoel Joâo Batista Castello Girão, Manoel Girão, Girão M
Journal of Minimally Invasive Gynecology · 2012 · vol. 19(3) , pp. 396–400 · doi:10.1016/j.jmig.2012.02.001 · PMID:22546428 · W2078456897
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This case report describes the laparoscopic decompression of sacral nerve roots and treatment of infiltrating endometriosis in a patient presenting with sciatica and urinary retention, leading to symptom resolution.

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Abstract

Endometriosis infiltrating the sacral nerve roots is a rarely reported manifestation of the disease. The objectives of this article are to report such a case and to describe the surgical technique for laparoscopic decompression of sacral nerve roots and treatment of endometriosis at this site. The patient as a 38-year-old woman who had undergone 2 previous laparoscopic procedures for electrocoagulation of peritoneal endometriosis and self-reported perimenstrual right-sided sciatica and urinary retention. Clinical examination revealed allodynia (pain from a stimulus that does not normally cause pain) on the S2 to S4 dermatomes and hypoesthesia on part of the S3 dermatome. Magnetic resonance imaging showed an endometriotic nodule infiltrating the anterior rectal wall. Laparoscopic exploration of the sacral nerve roots demonstrated vascular compression of the lumbosacral trunk and endometriosis entrapping the S2 to S4 sacral nerve roots, with an endometrioma inside S3. The endometriosis was removed from the sacral nerve roots and detached from the sacral bone, and a nodulectomy of the anterior rectal wall was performed. Normal urinary function was restored on postoperative day 2, and pain resolved after a period of post-decompression. Intrapelvic causes of entrapment of sacral nerve roots are rarely described in the current literature, either because of misdiagnosis or actual rareness of the condition. Recognition of the clinical markers for these lesions may lead to an increase in diagnosis and specific treatment.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Peripheral Nervous System Diseases Sciatica Spinal Nerve Roots Urinary Retention Endometriosis Endometriosis Endometriosis Female Humans Laparoscopy Peripheral Nervous System Diseases Peripheral Nervous System Diseases Peripheral Nervous System Diseases Sciatica Sciatica Sciatica Spinal Nerve Roots Spinal Nerve Roots Treatment Outcome

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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