Endometriosis

Alfred Cutner, Martin Hirsch
In: Lessons from Medicolegal Cases in Obstetrics and Gynaecology · 2022 · pp. 237–249 · doi:10.1017/9781108993388.021 · W4224306747
book-chapter OA: closed CC0
Full text JSON View on OpenAlex View at publisher
⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-13 ⓘ

A patient experienced abdominal pain for 18 years before a laparoscopy revealed advanced endometriosis, raising questions about delayed diagnosis and treatment compared to an IBS diagnosis.

One-sentence paraphrase of the abstract; not a substitute for reading it. No clinical advice. How this works

⚙ AI-generated deep summary by claude@2026-06, 2026-06-13 · read from full text ⓘ

This chapter in Lessons from Medicolegal Cases in Obstetrics and Gynaecology describes a medicolegal case involving a claimant with long-standing abdominal pain from age 18 to 36 years, initially managed as irritable bowel syndrome, before laparoscopy ultimately identified grade 4 endometriosis involving the ovaries, colon, and abdominal wall. The key allegations were that it was negligent to attribute symptoms to IBS alone, that endometriosis should have been considered earlier, and that laparoscopy should have been performed sooner despite unchanged symptoms after treatment. The main limitation is that the evidence is presented as a single case narrative within a broader medicolegal/clinical risk context rather than as generalizable clinical data. This paper is centrally about endometriosis — it uses a detailed medicolegal case to illustrate diagnostic and management shortcomings related to delayed recognition of severe endometriosis.

Read from the paper's body, not the abstract. Not a substitute for reading the paper. No clinical advice. How this works

Abstract

The claimant presented with abdominal pain from the age of 18 years through to the age of 36 years. When she finally underwent a laparoscopy, she was found to have grade 4 endometriosis which had spread around her ovaries, colon and the wall of the abdomen. She underwent treatment, but as the endometriosis was so far advanced it could not be fully treated and it was alleged: i) it had been negligent to consider her symptoms to be related to irritable bowel syndrome (IBS) alone; ii) there had been a failure to consider a diagnosis of endometriosis earlier; iii) there had been a failure to perform a laparoscopy earlier, even though her symptoms remained unchanged after treatment.
Full text 8,430 characters · extracted from oa-doi-fallback · click to expand
Lessons from Medicolegal Cases in Obstetrics and Gynaecology Buy print or eBook [Opens in a new window] Improving Clinical Practice - Lessons from Medicolegal Cases in Obstetrics and Gynaecology - Lessons from Medicolegal Cases in Obstetrics and Gynaecology - Copyright page - Dedication - Contents - List of Contributors - Preface - Foreword - Chapter 1 Recent Trends in Clinical Negligence Claims in England - Chapter 2 From Complaint to Litigation - Chapter 3 Being a Medicolegal Expert and Report Writing - Chapter 4 Consent: Legal and Clinical Implications - Chapter 5 Prenatal Diagnosis, Screening and Wrongful Birth - Chapter 6 Obstetric Perineal Trauma - Chapter 7 Medical Disorders of Pregnancy - Chapter 8 Fetal Growth Restriction and Unexplained Stillbirth - Chapter 9 Fetal Monitoring and the Challenges of Identifying the Fetus at Risk of Intrapartum Hypoxia - Chapter 10 Shoulder Dystocia - Chapter 11 Obstetric Haemorrhage and Retained Products of Conception - Chapter 12 Infection and Sepsis in Pregnancy - Chapter 13 Caesarean Section Including Uterine Rupture and Full Dilatation Caesarean Deliveries - Chapter 14 Assisted Vaginal Birth - Chapter 15 Breech Presentation and Delivery - Chapter 16 Multiple Pregnancy - Chapter 17 The Cervix: The Nemesis of Obstetrics and Gynaecology - Chapter 18 Hysterectomy for Heavy Menstrual Bleeding - Chapter 19 Endometriosis - Chapter 20 Miscarriage and Ectopic Pregnancy - Chapter 21 Ovarian Surgery, Menopause Hormone Therapy and Contraception - Chapter 22 Incontinence Surgery and Bladder Care - Chapter 23 Vaginal Prolapse - Chapter 24 Subfertility and Assisted Conception - Chapter 25 Gynaecological Precancer - Chapter 26 Gynaecological Malignancy - Index - References Published online by Cambridge University Press: 22 April 2022 Book contents - Lessons from Medicolegal Cases in Obstetrics and Gynaecology - Lessons from Medicolegal Cases in Obstetrics and Gynaecology - Copyright page - Dedication - Contents - List of Contributors - Preface - Foreword - Chapter 1 Recent Trends in Clinical Negligence Claims in England - Chapter 2 From Complaint to Litigation - Chapter 3 Being a Medicolegal Expert and Report Writing - Chapter 4 Consent: Legal and Clinical Implications - Chapter 5 Prenatal Diagnosis, Screening and Wrongful Birth - Chapter 6 Obstetric Perineal Trauma - Chapter 7 Medical Disorders of Pregnancy - Chapter 8 Fetal Growth Restriction and Unexplained Stillbirth - Chapter 9 Fetal Monitoring and the Challenges of Identifying the Fetus at Risk of Intrapartum Hypoxia - Chapter 10 Shoulder Dystocia - Chapter 11 Obstetric Haemorrhage and Retained Products of Conception - Chapter 12 Infection and Sepsis in Pregnancy - Chapter 13 Caesarean Section Including Uterine Rupture and Full Dilatation Caesarean Deliveries - Chapter 14 Assisted Vaginal Birth - Chapter 15 Breech Presentation and Delivery - Chapter 16 Multiple Pregnancy - Chapter 17 The Cervix: The Nemesis of Obstetrics and Gynaecology - Chapter 18 Hysterectomy for Heavy Menstrual Bleeding - Chapter 19 Endometriosis - Chapter 20 Miscarriage and Ectopic Pregnancy - Chapter 21 Ovarian Surgery, Menopause Hormone Therapy and Contraception - Chapter 22 Incontinence Surgery and Bladder Care - Chapter 23 Vaginal Prolapse - Chapter 24 Subfertility and Assisted Conception - Chapter 25 Gynaecological Precancer - Chapter 26 Gynaecological Malignancy - Index - References The claimant presented with abdominal pain from the age of 18 years through to the age of 36 years. When she finally underwent a laparoscopy, she was found to have grade 4 endometriosis which had spread around her ovaries, colon and the wall of the abdomen. She underwent treatment, but as the endometriosis was so far advanced it could not be fully treated and it was alleged: i) it had been negligent to consider her symptoms to be related to irritable bowel syndrome (IBS) alone; ii) there had been a failure to consider a diagnosis of endometriosis earlier; iii) there had been a failure to perform a laparoscopy earlier, even though her symptoms remained unchanged after treatment. - Type - Chapter - Information - Lessons from Medicolegal Cases in Obstetrics and GynaecologyImproving Clinical Practice, pp. 237 - 249Publisher: Cambridge University PressPrint publication year: 2022 Hirsch, M, Berg, L, Gamaledin, I, Vyas, S, Vashihst, A. The management of women with thoracic endometriosis: a national survey of British gynaecological endoscopists. Facts Views Vis Obgyn 2020; 12(4): 291–8.Google Scholar National Institute for Health and Care Excellence (NICE). Endometriosis: diagnosis and management. NICE Guideline [NG73]. 2017. Available at: www.nice.org.uk/guidance/ng73/documents/draft-guidelineGoogle Scholar Dunselman, GAJ, et al. ESHRE guideline: management of women with endometriosis. Hum Reprod 2014; 29(3): 400–12.Google Scholar Hirsch, M, Duffy, JMN, Davis, CJ, Nieves Plana, M, Khan, KS. Diagnostic accuracy of cancer antigen 125 for endometriosis: a systematic review and meta-analysis. BJOG 2016; 123(11): 1761–8.CrossRefGoogle ScholarPubMed NHS England. “NHS Standard Contract for Complex Gynaecology – Severe Endometriosis. Schedule 2 – The Services A. Service Specifications 2013. Available at: www.england.nhs.uk/wp-content/uploads/2018/08/Complex-gynaecology-severe-endometriosis.pdfGoogle Scholar Byrne, D, Curnow, T, Smith, P, Cutner, A, Saridogan, E, Clark, TJ. Laparoscopic excision of deep rectovaginal endometriosis in BSGE endometriosis centres: a multicentre prospective cohort study. BMJ Open 2018; (8); e018924–e018924.Google Scholar General Medical Council (GMC). Guidance on professional standards and ethics for doctors: decision making and consent. 2020. [Online]. Available at: www.gmc-uk.org/-/media/documents/updated-decision-making-and-consent-guidance_pdf-84160128.pdfGoogle Scholar Royal College of Obstetricians and Gynaecologists (RCOG). Advanced training skills module: advanced laparoscopic surgery for the excision of benign gynaecological disease. 2010. [Online]. Available at: www.rcog.org.uk/globalassets/documents/careers-and-training/atsms/atsm_advancedlaparoscopic_curriculum.pdfGoogle Scholar Royal College of Obstetricians and Gynaecologists (RCOG). Preventing Entry-related Gynaecological Laparoscopic Injuries. Green-top Guideline No. 49. 2008. [Online]. Available at: https://mk0britishsociep8d9m.kinstacdn.com/wp-content/uploads/2016/03/GtG-no-49-Laparoscopic-Injury-2008.pdfGoogle Scholar Fisher, G, Smith, RD, Saridogan, E, Vashisht, A, Allen, S, Arumuham, V, et al. Case selection for urological input in planned laparoscopic rectovaginal endometriosis surgery. Facts, Views & Vision in ObGyn 2019; 11(2): 111–17.Google Scholar Accessibility compliance for the HTML of this chapter is currently unknown and may be updated in the future. To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle. Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply. Find out more about the Kindle Personal Document Service. - Endometriosis - - Book: Lessons from Medicolegal Cases in Obstetrics and Gynaecology - Online publication: 22 April 2022 To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox. - Endometriosis - - Book: Lessons from Medicolegal Cases in Obstetrics and Gynaecology - Online publication: 22 April 2022 To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive. - Endometriosis - - Book: Lessons from Medicolegal Cases in Obstetrics and Gynaecology - Online publication: 22 April 2022

Text is read by the "Ask this paper" AI Q&A widget below. Extraction quality varies by source — PMC NXML preserves structure cleanly, OA-HTML may include some navigation residue, and OA-PDF can have broken hyphenation. The publisher copy (via DOI) is the canonical version.

My notes (saved in your browser only)

⚙ Ask this paper AI returns verbatim quotes from the full text · source: oa-doi-fallback ⓘ

Answers must be backed by verbatim quotes from this paper's full text. Hallucinated quotes are dropped automatically; if no verbatim passage answers the question, we say so. How this works

Condition tags

endometriosisirritable_bowel_syndrome

Citation neighborhood (sparse)

Too few in-corpus citations on either side for a chart; here are the lists.

Cites (4)

References (7)

Source provenance

openalex
last seen: 2026-06-10T17:14:06.276822+00:00
License: CC0 · commercial use OK