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1.
BMJ Case Rep ; 14(8)2021 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-34446516

RESUMO

We outline a case of vaginal endometriosis in scar tissue located in the distal part of the anterior vaginal wall close to the urethra following repeated urogynaecological surgery. Our case presents a 45-year-old woman diagnosed with pelvic endometriosis in her youth. She underwent several vaginal surgeries due to pelvic organ prolapse, symptoms of stress incontinence and decreased urinary flow. One year after her most recent vaginal surgery, she developed a tender lump in the lower part of the anterior vaginal wall. A urethral diverticulum was suspected, but a diagnostic puncture and biopsy unexpectedly showed histologically verified endometriosis. As the cyst recurred, surgical excision of all visible endometriosis tissue was performed. After 3 years of follow-up, the patient remained without recurrence. This case illustrates the risk of atypical implantation of endometriosis related to repeated urogynaecological surgery and that treatment requires surgery with thorough removal of all visible tissues.


Assuntos
Endometriose , Prolapso de Órgão Pélvico , Incontinência Urinária por Estresse , Doenças Vaginais , Adolescente , Endometriose/diagnóstico , Endometriose/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Incontinência Urinária por Estresse/etiologia , Incontinência Urinária por Estresse/cirurgia , Doenças Vaginais/etiologia , Doenças Vaginais/cirurgia
2.
Medicine (Baltimore) ; 100(29): e26699, 2021 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-34398042

RESUMO

BACKGROUND: Endometriosis (EMs) affects about 10% of women of childbearing age. It is defined as functional endometrial tissue appearing in other parts of the uterine cavity, manifested by varying degrees of pelvic pain and pelvic mass, etc. Therefore, to improve the therapeutic effect of endometriosis, we must constantly explore new ways to treat the disease. The purpose of this study is to evaluate the effectiveness and safety of the combined use of laparoscopy and traditional Chinese medicine in the treatment of patients with EMs. METHODS: A systematic literature search will be conducted at China National Knowledge Infrastructure, WanFang databases, VIP, SinoMed, PubMed, Embase, Web of Science, and the Cochrane library. The search period limit is from the time the date of database establishment to June 21, 2021. To ensure the comprehensiveness of the search, relevant references and conference literature are also included. The risk of bias in the final included studies will be evaluated based on the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. The RevMan software will be employed to perform data synthesis and statistical analysis. RESULTS: The effectiveness and safety of laparoscopic surgery combined with traditional Chinese medicine decoction in the treatment of patients with EMs will be systematically evaluated. CONCLUSION: The results of this study will provide strong evidence for judging whether laparoscopy combined with traditional Chinese medicine decoction is an effective strategy for the treatment of patients with EMs.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Endometriose/tratamento farmacológico , Terapia Combinada , Medicamentos de Ervas Chinesas/administração & dosagem , Endometriose/cirurgia , Feminino , Humanos , Laparoscopia , Fitoterapia , Projetos de Pesquisa
3.
BMJ Case Rep ; 14(8)2021 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-34429296

RESUMO

Bladder endometriosis accounts for 70%-85% cases of urinary tract endometriosis. A high index of suspicion is needed to diagnose this condition as most women have associated pelvic and menstrual complaints. The presence of cyclical haematuria along with tender anterior vaginal wall should alert the gynaecologist or urologist to consider this rare entity. Treatment is medical therapy followed by surgery when needed. Transurethral resection of endometriotic spot is the commonly used approach but to completely excise the endometriotic nodule, bladder resection at the site of nodule is needed along with repair of cut bladder margins. Herein, we describe a dual surgical approach where the margins of the endometriotic spot were delineated and cut using cystoscopy, followed by robotic approach to completely excise the nodule along with bladder repair. Robotic approach seems safer and easier in this complex surgery owing to dense adhesions in such cases.


Assuntos
Endometriose , Procedimentos Cirúrgicos Robóticos , Robótica , Cistectomia , Cistoscopia , Endometriose/diagnóstico , Endometriose/cirurgia , Feminino , Humanos , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/cirurgia
4.
J Int Med Res ; 49(8): 3000605211032788, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34407685

RESUMO

OBJECTIVE: This study aimed to compare outcomes of mini-invasive surgical treatment of endometriosis, especially conventional laparoscopy with robotic-assisted laparoscopy, and to evaluate the quality of life. METHODS: One hundred three consecutive patients with endometriosis who had surgery from 2014 to 2017 owing to an indication of pain were enrolled in this retrospective study. The majority (n = 77, 75%) of patients underwent conventional laparoscopy and 18 (17%) had robotic-assisted laparoscopy. The quality of life was postoperatively assessed with a questionnaire. RESULTS: The rates of parametrectomy (76% vs. 45%,) and rectovaginal resection (28% vs. 4%) were significantly higher in robotic-assisted laparoscopy than in laparoscopy. Additionally, the rate of bowel operations (50% vs. 17%), especially the shaving technique, was higher in robotic-assisted laparoscopy surgery than in laparoscopy (39% vs. 8%). There was no difference in the rate of postoperative complications between laparoscopy and robotic-assisted laparoscopy. Most (91%) of the patients who answered the questionnaire felt that surgical treatment had relieved their pain. In the laparoscopic and robotic-assisted groups, 88% of respondents felt that their quality of life had improved after surgery. CONCLUSIONS: This study suggests that robotic-assisted laparoscopy is a feasible method to resect deep infiltrating endometriosis, especially in the rectosigmoid area.


Assuntos
Endometriose , Laparoscopia , Procedimentos Cirúrgicos Robóticos , Endometriose/cirurgia , Feminino , Humanos , Complicações Pós-Operatórias/etiologia , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento
5.
Medicine (Baltimore) ; 100(30): e26753, 2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34397719

RESUMO

ABSTRACT: Triptorelin has been used after surgery in deep infiltrating endometriosis. This post-hoc analysis aimed to evaluate symptom control between patients receiving 1-3 triptorelin injections and those receiving 4-6 injections within 24 months of conservative surgery for deep infiltrating endometriosis, in the real-world.Included patients were divided into two groups (received up to 3 months injections in group A, 4-6 injections in group B) based on the numbers of triptorelin (Diphereline, 3.75 mg intramuscular injection once every 28 days for up to 24 weeks) administration. Evolution in score of pain intensity at 3, 6, 9, 12, 18, and 24 months after primary triptorelin administration and symptom improvement/recurrence rates between two groups were compared. Symptoms of pain intensity were assessed using a visual analogue scale (VAS) with a range from 0 to 10 cm. An improvement in symptoms was defined as a reduction of at least 3 cm or 3 units from pre-surgery levels.156 patients in group A and 228 in group B. Pain symptom score (mean ±â€Šstandard deviation) diminished to a nadir at 3-months for group A and 6-months for group B; at 6-months nadir scores were significantly lower in group B (0.9 ±â€Š1.7 vs 0.4 ±â€Š1.2 respectively, P = .002). No significant difference for pain symptom scores between both groups at 24-months (P = .269). The 6-month and 24-month cumulative improvement rates of pain (80.6% vs 89.8%, P = .014 and 82.6% vs 90.7%, P = .025) and gastro-intestinal symptoms (61.0% vs 80.8%, P = .022 and 61.0% vs 83.3%, P = .008) were significantly higher in group B, whereas there was no significant difference in rates of menstrual disorders and urinary symptoms. There is no significant difference for 12-months and 24-months cumulative recurrence rates of total symptoms between both groups (11.3% vs 13.8%, P = .568 and 16.1% vs 26.0%, P = .094).In women with deep infiltrating endometriosis, longer treatment with triptorelin following conservative surgery was associated with a decrease in symptom intensity and greater improvement of pain symptoms in the short-term and greater improvement of gastro-intestinal symptoms in the long-term.Trial registration number: ClinicalTrials.gov, NCT01942369.


Assuntos
Endometriose/tratamento farmacológico , Luteolíticos/administração & dosagem , Índice de Gravidade de Doença , Pamoato de Triptorrelina/administração & dosagem , Adulto , Terapia Combinada , Endometriose/cirurgia , Feminino , Humanos , Estudos Prospectivos
6.
BMJ Case Rep ; 14(8)2021 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-34404651

RESUMO

A 26-year-old woman, who underwent abdominal surgery because of pelvic endometriosis, suffered from upper abdominal pain, fever and dyspnoea 2 days postoperatively. Paralytic ileus and right-sided pneumothorax were revealed. Treatment with a chest drain was not successful and, thus, a video-assisted thoracoscopic surgery was performed, revealing endometriosis-like lesions. Basic histopathology did not confirm the visual diagnosis, but additional immunohistochemical staining for oestrogen and progesterone receptors showed positive reaction in epithelial lung cells, thus proved the diagnosis thoracic endometriosis. A resection of the apex of the right upper lobe and pleurodesis by talc poudrage was performed after which a mesh graft was applied on the diaphragm. After 5 years of follow-up, no recurrent pneumothorax occurred.


Assuntos
Endometriose , Pneumotórax , Adulto , Diafragma , Endometriose/diagnóstico , Endometriose/cirurgia , Feminino , Humanos , Pleurodese , Pneumotórax/etiologia , Recidiva , Cirurgia Torácica Vídeoassistida
8.
BMC Womens Health ; 21(1): 263, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34210307

RESUMO

BACKGROUND: Endometriosis of the uterine body can be manifested as diffuse solid lesions or cystic lesions. The former is common, while the latter is rare, especially for cystic adenomyosis larger than 5 cm. CASE PRESENTATION: A 30-year-old woman was admitted for severe and worsening dysmenorrhea. Ultrasound examination revealed a rare well-circumscribed cystic lesion about 5.5 × 4 × 5.0 cm. CA-125 level was slightly elevated. She accepted laparoscopic surgery and the adenomyotic tissues were excised. The histopathology of the specimen demonstrated the endometrial glands in the walls of cysts and an area of extensive hemorrhage can be seen in the inner wall of cyst. The patient made a good recovery after surgery and her symptoms complete resoluted. CONCLUSIONS: This is a rare case of a cystic adenomyotic lesion that was treated by laparoscopic surgery.


Assuntos
Adenomiose , Cistos , Endometriose , Laparoscopia , Adenomiose/diagnóstico por imagem , Adenomiose/cirurgia , Adulto , Cistos/diagnóstico por imagem , Cistos/cirurgia , Dismenorreia/etiologia , Endometriose/diagnóstico por imagem , Endometriose/cirurgia , Feminino , Humanos
9.
Eur J Obstet Gynecol Reprod Biol ; 263: 233-238, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34242932

RESUMO

OBJECTIVE: Management of ovarian endometrioma before IVF treatment is still challenging. We aimed to assess the effect of the pre-cycle surgical removal of endometriomas on IVF outcomes in a large number of cycles in patients undergoing IVF/ICSI treatment. Besides this, we also proposed to compare the cycle outcomes within both normo and poor responder patients to evaluate the impact of endometrioma and its surgery. STUDY DESIGN: A retrospective cohort study was conducted in a private IVF clinic between September 2014 and December 2018. A total of 2438 IVF/ICSI cycles of 1936 patients were reviewed. Patients who had previous endometrioma surgery (Group 1), patients with non-operated endometrioma (Group 2), and patients without endometriosis, including tubal factor infertility confirmed by laparoscopy and unexplained infertility without endometrioma (Group 3) were analyzed in this study. RESULTS: Total dose of gonadotropins was significantly higher in group 1 than others (p < 0.05). However, antral follicle counts, estradiol levels on the day of hCG trigger, the number of retrieved and metaphase II oocytes were significantly lower in group 1 than in other groups (p < 0.05). Poor response to gonadotropins was more frequent in group 1 as compared to other groups (47.9%, 34.3%, 35.5%, respectively) (p < 0.05). Cycle cancellation rates were significantly higher in group 1 than in other groups (6.7%, 1.4%, and 2.8%, respectively) (p < 0.05). Clinical pregnancy (CPR) and live birth rates (LBR) per cycle and embryo transfer were not different among groups. However, CPR per cycle and embryo transfer were significantly higher in the operated endometrioma group within unexpected poor responders (p = 0.023, p = 0.010, respectively). CPR and LBR per cycle and per embryo transfer were similar within normo-responder patients. Multiple logistic regression analysis revealed that female age and poor response to gonadotropins were the significant variables in predicting live birth (OR: 0.946, CI: 0.926-0.966, p < 0.001 and OR: 3.294, CI: 2.336-4.645, p < 0.001, respectively). CONCLUSION: Pre-cyle removal of endometrioma may have an adverse impact on ovarian reserve, and pregnancy outcomes seem to be similar with or without surgery in patients undergoing IVF treatment. However, endometrioma surgery may be considered in the subsequent IVF cycles of patients with lower than expected ovarian response.


Assuntos
Endometriose , Endometriose/cirurgia , Feminino , Fertilização In Vitro , Humanos , Indução da Ovulação , Gravidez , Taxa de Gravidez , Estudos Retrospectivos , Injeções de Esperma Intracitoplásmicas
10.
Trials ; 22(1): 473, 2021 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-34289889

RESUMO

BACKGROUND: Endometriosis (EMS) can be implanted everywhere, especially in pelvic organs. EMS can be asymptomatic, but it can result in pelvic pain and infertility by inducing local inflammation and pelvic adhesion. The prevalence of EMS is about 10% in reproductive-age women and higher in women with pelvic pain or infertility. For young patients with ovarian EMS, laparoscopic ovarian cystectomy is effective in relieving pelvic pain and preventing local recurrence. However, there is a concern that the ovarian reserve would decrease after the operation because of the removal of a part of the normal ovarian tissue and thermal damage during hemostasis, which depends on the types of hemostasis such as bipolar electrocoagulation, suturing, and the use of a hemostatic agent. In this study, we aim to evaluate the protective effect for the ovarian reserve and hemostasis between a hemostatic agent and suturing during laparoscopic ovarian cystectomy for patients with ovarian EMS. METHODS: This study is a randomized controlled, non-inferiority trial, where a total of 90 patients with ovarian EMS will be randomly assigned to the experimental (hemostatic agent) and control (suturing) groups. In the control group, a barbed suture will be applied for hemostasis, whereas a hemostatic agent will be applied in the experimental group. If two methods are insufficient, bipolar electrocoagulation will be applied for complete hemostasis. As the primary endpoint, the reduction rate of serum anti- Müllerian hormone (AMH) levels reflecting the ovarian reserve will be compared between the two groups 12 weeks after surgery. As secondary endpoints, we will compare the reduction rate of AMH level 48 weeks after surgery, the time required to complete hemostasis, the success rate of hemostasis within 10 min, and adverse events associated with operation. DISCUSSION: We expect that the protective effect for the ovarian reserve and hemostasis may be comparable between the two methods, suggesting that a hemostatic agent may be preferred considering that it is easy to use during laparoscopic ovarian cystectomy. TRIAL REGISTRATION: ClinicalTrials.gov NCT04643106 . Registered on 22 November 2020.


Assuntos
Endometriose , Hemostáticos , Laparoscopia , Reserva Ovariana , Hormônio Antimülleriano , Cistectomia , Endometriose/diagnóstico , Endometriose/cirurgia , Feminino , Hemostasia , Hemostáticos/efeitos adversos , Humanos , Laparoscopia/efeitos adversos , Recidiva Local de Neoplasia , Ensaios Clínicos Controlados Aleatórios como Assunto , Suturas
11.
BMJ Case Rep ; 14(7)2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34215635

RESUMO

Endometriosis is a benign estrogen-dependent disorder affecting women in their reproductive age group. Endometriosis means 'abnormal growth of endometrial glands' outside the uterus. Multiple theories on aetiopathogenesis of endometriosis have been postulated, Halban's theory on 'Benign Metastasis' which proposed the presence of endometriotic cells in lymphatic vessels and lymph nodes provides the basis of this case report. Here, we report a case of 26-year-old nulliparous woman who presented with grossly elevated CA 125 with endometriosis in her para-aortic nodes mimicking as ovarian cancer.


Assuntos
Neoplasias do Endométrio , Endometriose , Vasos Linfáticos , Neoplasias Ovarianas , Adulto , Neoplasias do Endométrio/cirurgia , Endometriose/cirurgia , Endométrio , Feminino , Humanos , Excisão de Linfonodo , Linfonodos
12.
BMC Womens Health ; 21(1): 271, 2021 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-34247612

RESUMO

BACKGROUND: Malignant transformation of endometriosis in extraovarian sites remains rare. Furthermore, the process is not definitely understood. CASE PRESENTATION: Herein, we report the case of a 40-year-old premenopausal nulligravida woman who presented with vaginal bleeding and who was finally diagnosed with a vaginal cancer originating from endometriosis and with a synchronous endometrial cancer. A gynecologic examination revealed a multiple polypoid mass on the posterior vaginal fornix. Magnetic Resonance Imaging of the pelvis showed two masses abutting respectively on the anterior uterine wall, and in the rectovaginal septum. The patient underwent a total laparoscopic excision of the rectovaginal mass, radical hysterectomy and low anterior resection of the rectum. The lesions were diagnosed as endometriosis, endometriosis-associated complex hyperplasia and endometrioid cancer. Furthermore, a synchronous endometrioid endometrial cancer was reported. CONCLUSIONS: This case revealed the multistep process of malignant transformation of deep infiltrating endometriosis. The progression was individualized between implantation sites and in the same organ.


Assuntos
Neoplasias do Endométrio , Endometriose , Laparoscopia , Neoplasias Vaginais , Adulto , Neoplasias do Endométrio/cirurgia , Endometriose/complicações , Endometriose/cirurgia , Feminino , Humanos , Histerectomia , Neoplasias Vaginais/cirurgia
13.
Clin J Gastroenterol ; 14(5): 1381-1385, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34189712

RESUMO

Endometriosis is the presence of normal endometrial tissue outside the uterus, which may appear in up to 15% of fertile female population. Bowel endometriosis is uncommon, and obstruction due to endometrial ileocolic intussusception is extremely rare. Herein, we report a case of a 27-year-old female who presented with bowel obstruction due to ileocolic intussusception secondary to endometriosis. A 27-year-old female, without pregnancies, and with a 1 year history of endometriosis presented to the emergency department referring severe abdominal pain in right lower quadrant, nausea and vomiting, she had medical history of prior episodes of mild abdominal pain due to endometriosis with OB/GYN follow-up. Physical examination revealed abdominal distension with decreased bowel movements to auscultation. A CT scan reported suspicion of intussusception. Colonoscopy was ordered, where an ileocolic intussusception was found. Diagnostic laparoscopy was performed, and the initial diagnosis was confirmed. A right hemicolectomy with extracorporeal anastomosis was achieved without any surgical complications. The patient was discharge on postoperative day 4 and continues doing well on a 12 month follow-up. Ileocolic intussusception due to endometriosis is a very rare condition, and it must be considered a differential diagnosis in female patients in reproductive age, when presenting with intestinal obstruction.


Assuntos
Endometriose , Doenças do Íleo , Obstrução Intestinal , Intussuscepção , Adulto , Colectomia , Endometriose/complicações , Endometriose/diagnóstico por imagem , Endometriose/cirurgia , Feminino , Humanos , Doenças do Íleo/diagnóstico por imagem , Doenças do Íleo/etiologia , Doenças do Íleo/cirurgia , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Intussuscepção/diagnóstico por imagem , Intussuscepção/etiologia , Intussuscepção/cirurgia
14.
Gynecol Obstet Invest ; 86(3): 299-306, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34157713

RESUMO

OBJECTIVE: The use of three-dimensional (3D) transvaginal ultrasonography (TVS) has been investigated for the diagnosis of deep endometriosis (DE). This study aimed to evaluate if 3D reconstructions improve the performance of TVS) in assessing the presence and characteristics of bladder endometriosis (BE). DESIGN: This was a single-center comparative diagnostic accuracy study. Participants/Materials, Setting, Methods: Patients referred to our institution (Piazza della Vittoria 14 Srl, Genova, Italy) with clinical suspicion of DE were included. In case of surgery, women underwent systematic preoperative ultrasonographic imaging; an experienced sonographer performed a conventional TVS; another experienced sonographer, blinded to results of the previous exam, performed TVS, with the addition of 3D modality. The presence and characteristics of BE nodules were described in accord with International DE Analysis group consensus. Ultrasound data were compared with surgical and histological results. RESULTS: Overall, BE was intraoperatively found in 34 out of 194 women who underwent surgery for DE (17.5%; 95% confidence interval: 12.8-23.5%). TVS without and with 3D reconstructions were able to detect endometriotic BE in 82.2% (n = 28/34) and 85.3% (n = 29/34) of the cases (p = 0.125). Both the exams similarly estimated the largest diameter of BE (p = 0.652) and the distance between the endometriotic nodule and the closest ureteral meatus (p = 0.341). However, TVS with 3D reconstructions was more precise in estimating the volume of BE (p = 0.031). In one case (2.9%), TVS without and with 3D reconstructions detected the infiltration of the intramural ureter, which was confirmed at surgery and required laparoscopic ureterovesical reimplantation. LIMITATIONS: The extensive experience of the gynecologists performing the ultrasonographic scans, the lack of prestudy power analysis, and the population selected, which may have been influenced by the position of the institution as a referral center specialized in the treatment of severe endometriosis, are limitations of the current study. CONCLUSION: Our results demonstrated the high accuracy of ultrasound for diagnosing BE. The addition of 3D reconstructions does not improve the performance of TVS in diagnosing the presence and characteristics of BE. However, the volume of BE may be more precisely assessed by 3D ultrasound.


Assuntos
Endometriose , Endometriose/diagnóstico por imagem , Endometriose/cirurgia , Feminino , Humanos , Estudos Prospectivos , Sensibilidade e Especificidade , Ultrassonografia , Bexiga Urinária
16.
Eur J Obstet Gynecol Reprod Biol ; 263: 20-24, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34144489

RESUMO

OBJECTIVE: The aim of the study is to show the coexistence of the endometriomas with peritoneal and deep infiltrating endometriosis, as well as with the adhesions. Study design It's a randomized retrospective study. Patients treated for endometrioma at Academic Hospital Cologne Weyertal from January 2014 to October 2019 were included. In total there were 1054 patients. 310 medical records were chosen at random without a special selection and the data were analysed. RESULTS: In our study, endometriomas were alone, which means without extraovarian endometriosis and/or adhesions, in only 2.3% of the cases. In the total population, 80.6% (250) of the patients had peritoneal endometriosis, 43.2% (134) of the patients had deep infiltrating endometriosis and 38% (118) of the patients had peritoneal and deep infiltrating endometriosis. In our analysis we found that in unilateral endometriomas there is no relationship between endometrioma size and adnexal adhesions. The risk of Douglas obliteration increases with the size of the endometriomas in unilateral endometriomas. In bilateral endometriomas, the risk of a complex adhesions is independent of the size of the endometriomas and relevantly higher than in unilateral endometriomas (Douglas obliteration 31.5% vs 16%, bilateral adnexal adhesions 45.2% vs 21.1%). Unilateral adnexal adhesions occurred in bilateral endometriomas only in 13.7%. CONCLUSION: Endometriomas are the relevant problem in gynaecological practice. It must be taken into account here that endometriomas usually occur with peritoneal endometriosis and that surgical therapy may be useful. However, adhesions and DIE are to be expected with surgical treatment, which could make the operation more difficult. Especially in large and bilateral endometriomas, a high coexistence with extraovarian endometriomas and adhesions is observed. Therefore, surgery should be performed by an experienced surgeon.


Assuntos
Endometriose , Doenças Ovarianas , Anexos Uterinos , Endometriose/complicações , Endometriose/cirurgia , Feminino , Humanos , Doenças Ovarianas/complicações , Doenças Ovarianas/cirurgia , Peritônio , Estudos Retrospectivos , Aderências Teciduais/complicações
17.
BMC Womens Health ; 21(1): 249, 2021 06 21.
Artigo em Inglês | MEDLINE | ID: mdl-34154577

RESUMO

BACKGROUND: Extrapelvic endometriosis is defined as the presence of ectopic endometrial tissue in structures outside the pelvis. Although extra-pelvic endometriosis is generally considered benign conditions, malignant potential within endometriotic foci occurs even after definitive surgery. Malignant transformation of hepatic endometriosis is extremely rare. Preoperative diagnosis of this cancer is difficult, and no guidelines on the optimal management currently exist. Here, we present a case report of malignant transformation of hepatic endometriosis and a brief literature review to highlight the current knowledge of the prevalence, clinical features, diagnosis, and management of this condition. CASE PRESENTATION: A 50-year-old woman with a 2-year duration of progressive right upper quadrant abdominal pain was admitted to the hospital. She underwent hysterectomy and bilateral salpingo-oophorectomy for benign conditions 4 years prior. Tumor markers demonstrated elevated carbohydrate antigen (CA)-199 112U/mL (normal range: 0-35U/mL) only. Radiological imaging suggested the presence of a 10.7 × 7.7-cm mass in the right lobe of the liver extending to the diaphragm. The intraoperative frozen sections suggested malignant tumor. Right hepatectomy with infiltrating diaphragm resection was performed. The final pathology with immunohistochemistry staining confirmed endometrioid adenocarcinoma in the liver originating from preexisting hepatic endometriosis. After the multidisciplinary team meeting, the consensus was surgery followed by adjuvant chemotherapy. To our knowledge, this is the first case of Chinese woman of a malignant liver tumor originating from endometriosis ever reported by reviewing the current English medical literature. CONCLUSION: Though rare, extrapelvic endometriosis-associated cancers should be considered as differentiated diagnosis even after hysterectomy and bilateral salpingo-oophorectomy. This case highlights the importance of collaborative efforts across multiple disciplines for accurate diagnosis and appropriate treatment of malignant transformation of hepatic endometriosis.


Assuntos
Carcinoma Endometrioide , Endometriose , Carcinoma Endometrioide/cirurgia , Endometriose/complicações , Endometriose/diagnóstico , Endometriose/cirurgia , Feminino , Humanos , Histerectomia , Fígado , Pessoa de Meia-Idade , Salpingo-Ooforectomia
18.
BMJ Case Rep ; 14(6)2021 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-34158326

RESUMO

An asymptomatic 39-year-old woman was noted to have occult bleeding by faecal immunohistochemical test. Investigations showed a 3 cm×2 cm caecal lesion by colonoscopy that was consistent with abdominal CT scan findings of a 1.6 cm×1.9 cm×2.3 cm enhancing focus in the medial caecal wall. The patient underwent laparoscopic right hemicolectomy after diagnostic laparoscopy and intraoperative colonoscopy revealed an intussuscepted appendix. The final histopathology was an appendiceal intussusception secondary to endometriosis.


Assuntos
Apêndice , Doenças do Ceco , Endometriose , Intussuscepção , Adulto , Apêndice/diagnóstico por imagem , Apêndice/cirurgia , Doenças do Ceco/diagnóstico , Doenças do Ceco/diagnóstico por imagem , Diagnóstico Diferencial , Endometriose/complicações , Endometriose/diagnóstico , Endometriose/cirurgia , Feminino , Humanos , Intussuscepção/diagnóstico por imagem , Intussuscepção/etiologia
20.
Acta Obstet Gynecol Scand ; 100(9): 1740-1746, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33999408

RESUMO

INTRODUCTION: Robot-assisted laparoscopic surgery (RALS) has gained widespread application in several surgical specialties. Previous studies on the feasibility and safety of RALS vs standard laparoscopy (S-LPS) for rectosigmoid endometriosis are limited and reported conflicting data. This study aims to compare S-LPS and RALS in patients with rectosigmoid endometriosis in terms of perioperative surgical and clinical data. MATERIAL AND METHODS: This is a multicentric, observational, prospective cohort study including 44 patients affected by rectosigmoid endometriosis referred to two tertiary referral centers for endometriosis from September 2018 to September 2019. Patients were divided into two groups: 22 patients underwent S-LPS, and 22 underwent RALS. Our primary outcome was to compare operative time (from skin incision to suture) between the two groups. Secondary outcomes included: operative room time (patient entry into operative room and patient out), estimated blood loss, laparotomic conversion rate, length of hospital stay, perioperative complications, and evaluation of endometriosis-related symptoms at 12-month follow up. RESULTS: The two groups were comparable regarding preoperative and surgical data, except for higher rates of hysterectomies and bilateral uterosacral ligament removal procedures in the RALS group. Also after adjusting for these discrepancies, operative time was similar between S-LPS and RALS. Operative room time was statistically longer in the RALS group compared with that of S-LPS. No statistically significant difference was found concerning other study outcomes. Pain and bowel symptoms improved in both groups at 12-month follow up. CONCLUSIONS: If performed by expert teams, RALS provides similar perioperative outcomes compared with S-LPS in rectosigmoid endometriosis surgical treatment, except for longer operative room time.


Assuntos
Endometriose/cirurgia , Doenças Retais/cirurgia , Adulto , Feminino , Humanos , Complicações Intraoperatórias , Itália , Laparoscopia , Duração da Cirurgia , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Robóticos , Resultado do Tratamento
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