Digital Presentation AGES XXVIII Annual Scientific Meeting 2018

A case of a concealed deep endometriotic nodule causing persistent pelvic pain despite multiple previous surgeries to treat endometriosis (5588)

Alan Lam 1 , Justin Lam 1 , Jessica Lowe 1 , Valerie To 1
  1. Centre for Advanced Reproductive Endosurgery, St. Leonards, NSW, Australia

The patient was a 43yo gravida 2 who had a longstanding history of dysmenorrhoea, dyspareunia and cyclical bowel symptoms. She had a past history of 5 previous surgeries for treatment of endometriosis including most recently a laparotomy, excision of endometriosis (including significant Pouch of Douglas disease) and insertion of Mirena in 2010 by a gynae-oncologist. After brief relief , she sought further opinion due to the impact of debilitating pain and bowel symptoms on her quality of life.

 

Despite normal pelvic ultrasound report  and  normal colonoscopy , when clinical examination demonstrated right uterosacral ligament thickening, tenderness in the Pouch of Douglas and nodularity on the anterior rectal wall, she was suspected  to have deep infiltrative endometriosis. After thorough pre-operative counselling including review by a colorectal surgeon, the patient chose to undergo laparoscopic hysterectomy and excision of endometriosis.

 

Aim: This video presentation highlights:

  • The importance of thorough clinical history and physical examination
  • The  limitations of imaging in pre-operative assessment  of deep endometriosis
  • The critical knowledge of sup-peritoneal pelvic anatomy for detection of deep endometriosis
  • Systematic surgical techniques for excision of severe deep endometriosis
  • In particular, how to remove pelvic sidewall endometriosis lying close to the obturator nerve and vessels.
  • Have you presented oral, video or DCS at an AGES meeting before?: Yes
  • Are you a trainee and if so at what level?: Not a trainee
  • Are you a subspecialists or AGES member?: No