|
1
|
Liang Y, Mei L, Ning Q, Zhang J, Fei J, Dong J. A Case of Rectal Endometriosis Misdiagnosed as Rectal Malignancy on Three Colonoscopies and Biopsies Sharing a Combined Literature Review. Int J Womens Health 2024; 16:163-174. [PMID: 38292299 PMCID: PMC10826710 DOI: 10.2147/ijwh.s445280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/11/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Endometriosis involves the intestine, and its clinical manifestations are nonspecific and lack of etiological manifestations. The diagnosis is difficult, which often leads to misdiagnosis. We report a case of endometriosis which was misdiagnosed as intestinal malignant tumor after colonoscopy and three biopsies. CASE PRESENTATION We reported a 42-year-old woman who went to see a doctor because of anal distension. She was examined by three gastrointestinal endoscopists at different levels in different hospitals and underwent biopsy at the same time. Combined with clinical manifestations, imaging examination, endoscopic examination and pathological examination, she was misdiagnosed as intestinal malignant tumor, and partial intestinal resection was performed according to the surgical principle of malignant tumor. CONCLUSION Although there are advanced gastrointestinal endoscopy and imaging techniques, intestinal endometriosis is still easy to be misdiagnosed. As our case report shows, after three colonoscopy and biopsy, it is still misdiagnosed as intestinal malignant tumor. Further research is needed to improve the ability of preoperative diagnosis, which deserves the attention of gastroenterologists and obstetricians and gynecologists.
Collapse
Affiliation(s)
- Yufei Liang
- Department of Gynaecology and Obstetrics, Huzhou Maternity & Child Health Care Hospital, Huzhou, People’s Republic of China
| | - Lina Mei
- Department of Digestive, Huzhou Maternity & Child Health Care Hospital, Huzhou, People’s Republic of China
| | - Qipeng Ning
- Department of Digestive, Huzhou Maternity & Child Health Care Hospital, Huzhou, People’s Republic of China
| | - Jiao Zhang
- Department of Digestive, Huzhou Maternity & Child Health Care Hospital, Huzhou, People’s Republic of China
| | - Jingying Fei
- Department of Ultrasound, Huzhou Maternity & Child Health Care Hospital, Huzhou, People’s Republic of China
| | - Jie Dong
- Department of Gynaecology and Obstetrics, Huzhou Maternity & Child Health Care Hospital, Huzhou, People’s Republic of China
| |
Collapse
|
|
2
|
El houss S, Laasri K, El Yousfi Z, El Halfi I, Nassar I, Billah NM. Isolated perineal endometriosis? Yes ... an exceptional location. Radiol Case Rep 2023; 18:4022-4025. [PMID: 37680667 PMCID: PMC10480675 DOI: 10.1016/j.radcr.2023.07.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/25/2023] [Accepted: 07/29/2023] [Indexed: 09/09/2023] Open
Abstract
Endometriosis is a nonmalignant condition characterized by the growth of endometrial tissue outside the uterus. Perineal endometriosis, an uncommon occurrence, involves the presence of endometrial tissue in the superficial perineum. In this report, we present a unique case of a 40-year-old woman with no known history of endometriosis. She had undergone an episiotomy 10 months prior and presented with swelling in the left perineal region, with no signs of inflammation or fever. To investigate the condition, a pelvic MRI was performed, revealing a rounded collection in the left perineal area, leading to the suspicion of perineal endometriosis based on the patient's pain pattern and medical history. The diagnosis was subsequently confirmed after drainage.
Collapse
Affiliation(s)
- Salma El houss
- Department of Radiology, Ibn Sina University Hospital, Mohamed V University, Rabat, Morocco
| | - Khadija Laasri
- Department of Radiology, Ibn Sina University Hospital, Mohamed V University, Rabat, Morocco
| | - Zakia El Yousfi
- Department of Radiology, Ibn Sina University Hospital, Mohamed V University, Rabat, Morocco
| | - Ismail El Halfi
- Department of Radiology, Ibn Sina University Hospital, Mohamed V University, Rabat, Morocco
| | - Ittimade Nassar
- Department of Radiology, Ibn Sina University Hospital, Mohamed V University, Rabat, Morocco
| | - Nabil Moatassim Billah
- Department of Radiology, Ibn Sina University Hospital, Mohamed V University, Rabat, Morocco
| |
Collapse
|
|
3
|
Liang Y, Zhang D, Jiang L, Liu Y, Zhang J. Clinical characteristics of perineal endometriosis: A case series. World J Clin Cases 2021; 9:1037-1047. [PMID: 33644167 PMCID: PMC7896645 DOI: 10.12998/wjcc.v9.i5.1037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/20/2020] [Accepted: 12/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The prevalence of perineal endometriosis (PEM) is low among women with endometriosis (EM) treated by surgery. It manifests as hard or cystic nodules with pain in the perineal wounds and surrounding areas. Implantation theory is regarded as the main pathogenesis of PEM. There are few clinical studies on the incidence and clinical characteristics of PEM. This study aims to summarize the clinical data of 14 PEM cases and analyze the factors that may be related to the incubation period and pain.
AIM To analyze the medical history, clinical manifestations, diagnosis, treatment and treatment effect of PEM.
METHODS The present study is a case series. We collected the clinical data and follow-up data of 14 patients with PEM who visited The International Peace Maternal and Child Health Hospital Affiliated to Shanghai Jiaotong University from January 2009 to December 2019. Paired t test and Pearson correlation analysis were used for statistical analysis. P < 0.05 was considered statistically significant.
RESULTS The 14 patients included had a history of vaginal delivery. All patients underwent PEM lesion resection. Three patients were treated by levator ani muscle repair at the same time and 1 patient underwent extensive PEM lesion resection and anal sphincter repair. Body mass index (BMI) at delivery and BMI within 1 mo after delivery were negatively correlated with the latent period, respectively (R2 = 0.53/0.86, P < 0.05). The average visual analog scale score in lesions at the third month after surgery was 0.57 ± 1.28 for all patients, which was significantly lower than that prior to surgery (P < 0.05). One patient relapsed during the sixth month after surgery, and to date, no recurrence occurred after the second surgery.
CONCLUSION The higher the BMI during delivery and within 1 mo after delivery, the shorter the incubation period of PEM. It is very important to evaluate the location of lesions before surgery. Surgical resection of the lesion is the best treatment for PEM and results in significant alleviation of symptoms. Therefore, following the diagnosis of PEM, immediate surgery is recommended.
Collapse
Affiliation(s)
- Yan Liang
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, Shanghai 200030, China
- Shanghai Key Laboratory Embryo Original Diseases, China
| | - Duo Zhang
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, Shanghai 200030, China
- Shanghai Key Laboratory Embryo Original Diseases, China
| | - Ling Jiang
- Department of Radiology, International Peace Maternity and Child Health Hospital, Shanghai 200030, China
- Shanghai Key Laboratory Embryo Original Diseases, China
| | - Yuan Liu
- Department of Pathology, International Peace Maternity and Child Health Hospital, Shanghai 200030, China
- Shanghai Key Laboratory Embryo Original Diseases, China
| | - Jian Zhang
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, Shanghai 200030, China
- Shanghai Key Laboratory Embryo Original Diseases, China
| |
Collapse
|
|
4
|
Chen N, Zhu L, Lang J, Liu Z, Sun D, Leng J, Fan Q, Zhang H, Cui Q. The clinical features and management of perineal endometriosis with anal sphincter involvement: a clinical analysis of 31 cases. Hum Reprod 2012; 27:1624-7. [PMID: 22422793 DOI: 10.1093/humrep/des067] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the appropriate measures for diagnosing and treating perineal endometriosis (PEM) with anal sphincter involvement. METHODS Between January 1992 and April 2011, the clinical features, diagnosis and management of 31 patients who were diagnosed with PEM with anal sphincter involvement at the Peking Union Medical College Hospital were retrospectively analyzed using their clinical records. A range of 6-78 months of outpatient follow-up after surgery were conducted for these 31 patients but was extended by telephone interviews with 29 patients conducted in December 2011. RESULTS All 31 patients had a history of vaginal delivery. The level of serum CA(125) was elevated in only 2 (6.5%) cases. All cases received surgical treatment, which included narrow excision (NE, close to the edge of the endometrioma) with primary sphincteroplasty (PSp) for 30 cases and incomplete excision (IE) for 1 case. Of the 30 cases in the NE group, 20 (66.7%) received hormone therapy preoperatively. Up until December 2011, there was one recurrence (3.6%) of PEM in the NE group. PEM relapse occurred in the IE patient 6 years after the initial IE surgery. Perineal abscesses were found in one patient post-operatively. No complaint of dyspareunia and no fecal incontinence episodes were observed during follow-up. CONCLUSIONS Based on our own experience, NE and PSp may be indicated for the treatment of PEM with anal sphincter involvement.
Collapse
Affiliation(s)
- Na Chen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, People's Republic of China
| | | | | | | | | | | | | | | | | |
Collapse
|
|
5
|
Regadas SMM, Regadas FSP, Rodrigues LV, Silva FR, Lima DMDR, Regadas-Filho FSP. Importância do ultra-som tridimensional na avaliação anorretal. ARQUIVOS DE GASTROENTEROLOGIA 2005; 42:226-32. [PMID: 16444377 DOI: 10.1590/s0004-28032005000400007] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
RACIONAL: A endosonografia anorretal constitui-se atualmente no principal exame de imagem para avaliar algumas das afecções anorretais. OBJETIVO: Demonstrar a importância do ultra-som tridimensional na avaliação anatômica do canal anal e no diagnóstico de afecções anorretais. MÉTODO: Foram realizados 74 exames, sendo 23 pacientes normais (13 mulheres) e 51 com afecções benignas e malignas (33 mulheres). Foi utilizado um aparelho de ultra-som com transdutor tridimensional 360°. Os indivíduos normais foram avaliados em plano sagital mediano, com relação ao comprimento do canal anal, do esfíncter anal interno, do esfíncter anal externo e do defeito anatômico, no quadrante anterior. RESULTADOS: Comparando homens normais com as mulheres, não houve diferenças no comprimento médio do canal anal e do esfíncter anal interno. Já o comprimento médio do esfíncter anal externo é maior no homem e o defeito anatômico anterior é maior na mulher. Nos doentes com afecções anorretais, foram diagnosticadas 11 lesões esfincterianas, 8 fístulas anais, 7 abscessos, 1 endometriose perirretal, 1 cisto pré-sacral, 3 tumores no canal anal e 10 no reto. Houve coincidência entre os achados cirúrgicos e ultra-sonográficos em todos os pacientes operados. CONCLUSÃO: A avaliação ultra-sonográfica tridimensional evidenciou as diferenças anatômicas entre os sexos, justificando a maior freqüência de distúrbios do assoalho pélvico no sexo feminino. Diagnosticou as afecções anorretais em múltiplos planos com elevada resolução espacial, adicionando informações importantes para a decisão terapêutica, assemelhando-se à ressonância nuclear magnética com bobina intra-retal, com a vantagem de ser mais fácil, mais rápido, de baixo custo e com melhor tolerância.
Collapse
|
|
6
|
Hernández-Magro PM, Villanueva Sáenz E, Alvarez-Tostado Fernández F, Luis Rocha Ramírez J, Valdés Ovalle M. Endoanal sonography in the assessment of perianal endometriosis with external anal sphincter involvement. JOURNAL OF CLINICAL ULTRASOUND : JCU 2002; 30:245-248. [PMID: 11981936 DOI: 10.1002/jcu.10055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Endoanal sonography can be used in the assessment of benign and malignant anal conditions and to evaluate the anatomy of the anal sphincters. We used endoanal sonography with a 10-MHz rotating endocavitary probe to evaluate a 45-year-old woman with a perianal mass, fecal incontinence, and menses-associated perianal pain. She had had 2 vaginal deliveries requiring episiotomies. Biopsy of the mass showed endometrial tissue. The ultrasound examination showed a perianal mass and an external anal sphincter injury. A wide excision and sphincteroplasty were performed, with improvement of fecal continence and pain. Histopathologic examination of the mass confirmed perianal endometrioma in an episiotomy scar.
Collapse
Affiliation(s)
- Paulino Martínez Hernández-Magro
- Colon and Rectal Surgery Department, Hospital de Especialidades Centro Médico Nacional SXXI, Instituto Mexicano del Seguro Social, Colonia Héroes de Padierna, Codigo Postal 10700, Torre Angeles Consultorio 927, México City, México
| | | | | | | | | |
Collapse
|
|
7
|
Abstract
Anal endosonography became a valuable imaging method for diagnosis of anal diseases because of its accessibility, relative simplicity of performance, and low cost. It is used most often to detect anal sphincter defects, to classify anal fistulas and perianal abscesses, and to stage anal tumors. This review presents a normal anatomy of the anal canal, examination technique, and normal endosonographic anatomy of anal sphincters. The endosonographic findings of anal sepsis, malignancy, trauma, abnormalities in Crohn disease, and ulcerative colitis, as well as the role for anal endosonography among other imaging modalities, are discussed.
Collapse
|
|
8
|
Vallet Fernández J, Pi Siqués F, Sueiras Gil A, Calabuig Escoda R, Ortiz Rodríguez C. Oclusión intestinal baja de instauración aguda como forma rara de presentación de endometriosis. Cir Esp 2001. [DOI: 10.1016/s0009-739x(01)71772-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|