Extragenital endometriosis
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Transcript of Extragenital endometriosis
EXTRAGENITAL ENDOMETRIOSISDr. Bulent UrmanKoc University School of MedicineDepartment of Obstetrics and GynecologyAmerican Hospital of Istanbul
Extragenital endometriosisEndometriosis involving other organs
Rectovaginal septum or retrocervicalIntestinalBladderAbdominal wallDiaphragmThoracic
Diagnosis is difficultCyclic symptoms may give a clue
Bowel endometriosis• Bowel endometriosis is reported to be present in 5-40% of
patients with pelvic endometriosis • Rectum and sigmoid are the most common sites (up to
95% of cases)• 5-20% of the cases have appendix endometriosis• Endometriosis of the small bowel is rare
Symptoms• Chronic abdominal pelvic pain• Dyschezia (pain during defecation during menstrual
period)• Dysmenorrhoea• Dyspareunia• Tenesmus,• Constipation or diarrhea• Rectal bleeding
Treatment• Aysmptomatic patient-Watchful waiting• Symptomatic patient-Surgery
• Shaving of superficial lesions• Discoid resection/anterior rectal wall excision• Segmental colorectal resection-anastomosis
Surgical treatment of DIE with colorectal involvementBowel surgery N (%) Previous
surgeriesIndication Histological
confirmation
Mixed Procedures
17 studies 1791 patients
Resection/ anastomosis
737 (39.9%) 58.8% Pain (62.9%) 83.2%
Full thickness disc excision
375 (20.3%)
Shaving/ superficiaal excision
679 (36.8%)
Only resection and anastomosis
32 studies 2039 patients
59% Pain 75.2%Pain and infertility 24.8%
99.2%
From Meuleman HR Update 2011
A-Complete segmental resectionB-Residual diseaseC-No bowel endo From Stepnievska et al. F&S 2010
Long term follow-up of patients who underwent LS surgery for colorectal endometriosis
Laparoscopic procedures performed for deep infiltrating endometriosis (n=101)Procedure Number
Dissection of the culdesac+resection or shaving of the uterosacral ligaments
26
Dissection of the culdesac+deep endometriosis nodule excision
37
Dissection of the culdesac+shaving of rectal and sigmoid endometriosis lesions
8
Dissection of the culdesac and+rectal resection 11Dissection of the culdesac+nodule excision and rectal resection
10
Dissection of the culdesac+sigmoid colon resection 7Dissection of the culdesac+nodule excision+rectal resection+partial cyctectomy
2
American Hospital Data (unpublished)
Complications (Bowel endometriosis-mixed surgery n=38)Complication Number
Fistula formation 0Temporary voiding problems 2Infection 0Follow-up 1-38 moRecurrence of bowel lesions 2/38Recurrence of pain 21 (20.8%)
Diagnosis• Palpation• US• MRI-the presence of blood products in an anterior abdominal wall
mass at magnetic resonance (MR) imaging with no other explanation is strongly suggestive of scar endometriosis (RadioGraphics 2012; 32:2031–2043)
• Fine needle aspiration biopsy (Journal of Cytology / January 2015 / Volume 32 / Issue 1)
Treatment• Medical treatment is not successful (Hensen et al. AJR
2006)• Wide surgical excision is necessary
Other sites of extragenital endometriosis
• Bowel• Bladder• Skin• Diaphgram• Lung• Kidney• Liver• CNS and the spine• Pericardium• Leg• Eyes, nose, ears