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Kim J, Yun JA, Youn S, Park MO. Endometriosis presenting as a perianal abscess: case report. J Surg Case Rep 2024; 2024:rjae402. [PMID: 38835945 PMCID: PMC11149556 DOI: 10.1093/jscr/rjae402] [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: 04/26/2024] [Accepted: 05/18/2024] [Indexed: 06/06/2024] Open
Abstract
Endometriosis is common benign disorder characterized by the presence of endometrial glands and stroma outside the uterine cavity. Endometriosis of perianal region is a rare condition. We report a case of perianal endometriosis presenting initially as a perianal abscess. Transperineal ultrasound showed a 1.5 cm size irregular mixed echogenicity lesion without involving anal sphincters. Complete surgical excision was performed. The histopathological examination confirmed as endometriosis.
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Affiliation(s)
- Jieun Kim
- Department of Surgery, Centum Surgical Clinic, 142, Anyang-ro, Manan-gu, Anyang-si, Gyeonggi-do 14034, South Korea
| | - Jung-A Yun
- Department of Surgery, Centum Surgical Clinic, 142, Anyang-ro, Manan-gu, Anyang-si, Gyeonggi-do 14034, South Korea
| | - Sangmin Youn
- Department of Surgery, Centum Surgical Clinic, 142, Anyang-ro, Manan-gu, Anyang-si, Gyeonggi-do 14034, South Korea
| | - Mi-Ok Park
- MioGreensumer Pathology Clinic, Room 705, Seochangvisionplaza Bldg., 55, Seochangbangsan-ro, Namdong-gu, Incheon 21617, South Korea
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Maillard C, Cherif Alami Z, Squifflet JL, Luyckx M, Jadoul P, Thomas V, Wyns C. Diagnosis and Treatment of Vulvo-Perineal Endometriosis: A Systematic Review. Front Surg 2021; 8:637180. [PMID: 34046423 PMCID: PMC8148344 DOI: 10.3389/fsurg.2021.637180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 04/06/2021] [Indexed: 11/15/2022] Open
Abstract
Objective: To describe the available knowledge on vulvo-perineal endometriosis including its diagnosis, clinical management and recurrence rate. Methods: We followed the PRISMA guidelines for Systematic Reviews and our study was prospectively registered with PROSPERO (CRD42020202441). The terms “Endometriosis” and “Perineum” or “Vulva” were used as keywords. Cochrane Library, Medline/Pubmed, Embase and Clinicaltrials.gov were searched. Papers in English, Spanish, Portuguese, French or Italian from inception to July 30, 2020 were considered. Reference lists of included articles and other literature source such as Google Scholar were also manually scrutinized in order to identify other relevant studies. Two independent reviewers screened potentially eligible studies according to inclusion criteria. Results: Out of 539 reports, 90 studies were eligible including a total of 283 patients. Their mean age was 32.7 ± 7.6 years. Two hundred sixty-three (95.3%) presenting with vulvo-perineal endometriosis have undergone either episiotomy, perineal trauma or vaginal injury or surgery. Only 13 patients (4.7%) developed vulvo-vaginal endometriosis spontaneously i.e., without any apparent condition favoring it. The reasons that motivated the patients to take medical advice were vulvo-perineal cyclical pain increasing during menstruations (98.2% of the patients, n = 278). Out of the 281 patients for whom a clinical examination was described, 274 patients (97.5%) showed a vulvo-perineal nodule, mass or swelling while six presented with bluish cutaneous lesions (2.1%) and 1 with bilateral polyps of the labia minora (0.4%). All but one patients underwent surgical excision of their lesions but only 88 patients (28.1%) received additional hormonal therapy. The recurrence rate was 10.2% (29 patients) considering a median follow-up period of 10 months (based on 61 studies). Conclusion: In conclusion, vulvo-perineal endometriosis is a rare entity with approximately 300 cases reported in the literature since 1923. With the available knowledge shown in this systematic review, we encourage all practitioners to think about perineal endometriosis in case of perineal cyclical pain with or without previous perineal damage. Diagnosis should be done with clinical exam, perineal ultrasound and pelvic MRI when available. In case of anal sphincter involvement, perianal ultrasound should be performed. Surgical excision of the lesion should be realized in order to remove the lesion and to confirm the diagnosis histologically. Hormonal treatment could be proposed to attempt to decrease the size of a large lesion before surgery or to avoid recurrence of the lesion. As evidence-based approach to the diagnosis, treatment and recurrence rate of affected patients remains a challenge given its low prevalence, the variations in management found in the articles included and the limited quality of available studies, we suggest that a prospective database on vulvo-perineal endometriosis should be generated to increase knowledge but also awareness among healthcare professionals and optimize patients' care. Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, identifier: CRD42020202441.
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Affiliation(s)
- Charlotte Maillard
- Department of Gynecology-Andrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Zineb Cherif Alami
- Department of Obstetrics and Gynecology, Clinique Saint-Jean, Brussels, Belgium
| | - Jean-Luc Squifflet
- Department of Gynecology-Andrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Mathieu Luyckx
- Department of Gynecology-Andrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.,Tumor Infiltrating Lymphocytes Group - De Duve Institute, Université Catholique de Louvain, Brussels, Belgium
| | - Pascale Jadoul
- Department of Gynecology-Andrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Viju Thomas
- Department of Obstetrics and Gynecology, Tygerberg Hospital, University of Stellenbosch, Cape Town, South Africa
| | - Christine Wyns
- Department of Gynecology-Andrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.,Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
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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.
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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
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Taggart MW, Foo WC, Lee SM. Tumors of the Gastrointestinal System Including the Pancreas. ONCOLOGICAL SURGICAL PATHOLOGY 2020:691-870. [DOI: 10.1007/978-3-319-96681-6_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
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Darwish B, Leleup G, Martin C, Roman H. Our experience with long-term triptorelin therapy in a large endometriosis nodule arising in an episiotomy scar. ACTA ACUST UNITED AC 2015; 43:757-8. [DOI: 10.1016/j.gyobfe.2015.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 09/11/2015] [Indexed: 02/07/2023]
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Grimstad FW, Carey E. Periclitoral endometriosis: the dilemma of a chronic disease invading a rare location. J Minim Invasive Gynecol 2015; 22:684-6. [PMID: 25680686 DOI: 10.1016/j.jmig.2015.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 02/03/2015] [Accepted: 02/03/2015] [Indexed: 02/06/2023]
Abstract
Endometriosis affects 6% to 10% of women of reproductive age; extrapelvic endometriosis is considered a rare event with perineal endometriosis being even rarer still (only a few cases of spontaneous episodes described, the majority being from episiotomy scars). We present a unique case of periclitoral endometriosis, which to the best of our knowledge is the first in the literature. It is a 29-year-old nulligravida female with a painful fluctuant right periclitoral mass that had been growing with no response to antibiotic therapy. At the initial removal, pathology reported the lesion as endometriosis. The patient was placed on oral contraceptives, and she was noted to have monthly swelling and shrinking of the site with her menstrual cycles. When she went off hormonal contraception, she represented with the growing lesion 3.5 weeks after her last menses; she underwent re-excision. Because of the extension of the lesion medially and its adherence to the clitoral body, the decision was made to evacuate only as much of the capsule that could be safely identified to minimize the risk of damaging the clitoris. Complete excision in this case was difficult without sacrificing a portion of the clitoris and potentially resulting in decreased sexual function and persistent clitoral pain. In a patient in whom complete excision is not possible, there is potential for mass recurrence in the setting of residual tissue. Reviewing the literature suggests that there are risks with both recurrence and clitoral excision. We found that in-depth patient counseling, hormonal suppression, and close follow-up are necessary when dealing with periclitoral endometriosis postexcision.
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Affiliation(s)
- Frances W Grimstad
- Department of Obstetrics and Gynecology, University of Kansas, Kansas City, Kansas.
| | - Erin Carey
- Department of Obstetrics and Gynecology, University of Kansas, Kansas City, Kansas
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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.
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Affiliation(s)
- Na Chen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, People's Republic of China
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Odobasic A, Pasic A, Iljazovic-Latifagic E, Arnautalic L, Odobasic A, Idrizovic E, Dervisefendic M, Dedić L. Perineal endometriosis: a case report and review of the literature. Tech Coloproctol 2010; 14 Suppl 1:S25-7. [DOI: 10.1007/s10151-010-0642-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Zhu L, Lang J, Wang H, Liu Z, Sun D, Leng J, Zhou H, Cui Q, Wong F. Presentation and management of perineal endometriosis. Int J Gynaecol Obstet 2009; 105:230-2. [PMID: 19329117 DOI: 10.1016/j.ijgo.2009.01.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Revised: 01/05/2009] [Accepted: 01/23/2009] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To analyze the clinical presentation of perineal endometriosis and evaluate its treatment. METHODS Clinical data were analyzed from the records of 36 patients with perineal endometriosis who were operated on between 1983 and 2007 at Peking Union Medical College Hospital, and followed up for 0.5 to 14 years. RESULTS The incidence of perineal endometriosis was 0.31% among the women with endometriosis treated surgically at the hospital. The latent period was between 4 months and 13 years. All patients had cyclical and painful lesions. Of the 36 patients, 5 (13.9%) also suffered from pelvic endometriosis. All patients without anal sphincter involvement were cured after complete surgical excision. In 7 patients who had anal sphincter involvement, disease recurred because of incomplete excision. CONCLUSION Perineal endometriosis can be diagnosed on the basis of clinical features and surgical excision is the treatment of choice. The recurrence rate of perineal endometriosis is related to sphincter involvement making preoperative evaluation of anal sphincter important.
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Affiliation(s)
- Lan Zhu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China.
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Abstract
Tumors of the anal canal and anal margin are rare. They may raise specific problems for the pathologist. Benign tumors mainly consist of condylomas, cloacogenic polyps and fibro-epithelial polyps. Cancers are infrequent and consisted of well-differentiated squamous cell carcinoma, or poorly differentiated basaloid squamous cell carcinoma. The other malignant tumors are very rare.
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Park SB, Kim JK, Cho KS. Sonography of endometriosis in infrequent sites. JOURNAL OF CLINICAL ULTRASOUND : JCU 2008; 36:91-97. [PMID: 18067126 DOI: 10.1002/jcu.20431] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We reviewed the sonographic features of endometriosis in infrequent sites, including the abdominal wall, appendix, perineum, and bladder. Familiarity with the clinical setting and the sonographic appearance of endometriosis in both frequent and infrequent sites can help facilitate prompt, accurate diagnosis and treatment.
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Affiliation(s)
- Sung Bin Park
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, South Korea
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13
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Chene G, Darcha C, Dechelotte P, Mage G, Canis M. Malignant degeneration of perineal endometriosis in episiotomy scar, case report and review of the literature. Int J Gynecol Cancer 2007; 17:709-14. [PMID: 17300680 DOI: 10.1111/j.1525-1438.2007.00822.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Although malignant degeneration of cutaneous endometriosis is rare at only 0.3-1% in endometriosis surgical scars, diagnosis and management need to be defined. A case of malignant degeneration of perineal endometriosis is reported, with a review of literature. Physiopathology, epidemiological data, diagnostic and therapeutic methods are discussed for malignant degeneration of cutaneous endometriosis. Any scar lesion that evolves in response to the menstrual cycle should be considered endometriosis until proven otherwise, and thus could require surgical resection, with histological analysis. A history of cutaneous endometriosis with frequent recurrences can indicate malignant degeneration. All cases require long-term clinical follow-up because, despite the rarity of this diagnosis, the delay between benign endometriosis and malignant transformation can vary from a few months to over 40 years.
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Affiliation(s)
- G Chene
- Department of Obstetrics, Gynecology and Reproductive Medicine, CHU Polyclinique, Clermont-Ferrand, France.
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Barisic GI, Krivokapic ZV, Jovanovic DR. Perineal endometriosis in episiotomy scar with anal sphincter involvement: report of two cases and review of the literature. Int Urogynecol J 2006; 17:646-9. [PMID: 16231117 DOI: 10.1007/s00192-005-0022-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2005] [Accepted: 09/05/2005] [Indexed: 02/06/2023]
Abstract
Perineal endometriosis with anal sphincter involvement is a rare occurrence with only nine cases reported so far. Two such cases are presented, and the literature is reviewed. In presented cases, diagnosis was suspected at clinical exam. Anal manometry was performed in both cases and endoanal ultrasound in one case. Wide surgical excision of endometriotic mass together with part of external anal sphincter was carried out in both cases. The procedure was followed by anal sphincter reconstruction in an "overlapping" fashion in the first and "apposition" technique in the second case. Histopathologic tests confirmed endometriosis. The recovery was uneventful in both cases with excellent functional results. Two years after the operation, patients are asymptomatic and fully continent. According to the literature and our own experience, wide excision of endometrioma with primary sphincteroplasty seems to be the best chance of cure with satisfactory functional results and should be recommended.
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Affiliation(s)
- Goran I Barisic
- First Surgical Clinic, Clinical Center of Serbia, Institute for Digestive Diseases, Koste Todorovica 6, 11000 Belgrade, Serbia and Montenegro.
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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.
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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
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Affiliation(s)
- William H Isbister
- Department of Surgery, King Faisal Specialist Hospital, Riyadh, Kingdom of Saudi Arabia.
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