Endometriosis After Surgical Menopause Mimicking Pelvic Malignancy: Surgeons’ Predicament

Rani A Bhat, Rani Akhil Bhat, Melissa C.C. Teo, Melissa Teo, Akhil Krishnanand Bhat
Oman medical journal · 2014 · vol. 29(3) , pp. 226–231 · doi:10.5001/omj.2014.56 · PMID:24936277 · W2141626445
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This case report describes a postmenopausal woman whose endometriosis mimicked pelvic malignancy, presenting with hemoperitoneum and a pelvic mass requiring surgical resection.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 ⓘ

This paper reports a rare case of endometriosis occurring after surgical menopause in a 50-year-old woman previously treated with total hysterectomy and bilateral salpingo-oophorectomy for deeply infiltrating endometriosis, who presented with hemoperitoneum, vaginal bleeding, a large pelvic mass, and pulmonary thromboembolism mimicking rectovaginal septum carcinoma. Using high-level diagnostic workup (including CT, tumor markers CA-125 and CA-19.9), the authors describe emergency embolization for active bleeding followed by en bloc resection involving rectal surgery, with histopathology confirming endometriosis-related findings rather than malignancy. The discussion highlights proposed mechanisms such as ovarian remnant syndrome, residual hormonal activity, and other theories, while explicitly noting limitations including lack of preoperative estradiol/FSH measurements to confirm menopausal status. This paper is centrally about endometriosis — it presents and interprets endometriosis after surgical menopause that mimicked pelvic malignancy.

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Abstract

Prevalence of persistent endometriosis in women after menopause without any hormonal replacement therapy is very rare. This is a case of a woman with previous history of total hysterectomy and bilateral salpingo-oophorectomy for endometriosis who presented with hemoperitoneum, vaginal bleeding, pelvic mass, and pulmonary thromboembolism mimicking as rectovaginal septum carcinoma. This is the first case report with a unique mode of presentation wherein the patient presented with hemoperitoneum requiring emergency embolization of the vessel to stabilize the patient. She underwent en bloc resection of the tumor with high anterior resection of the rectum. Histopathology confirmed endometriosis.

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endometriosis

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