Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 16, 2021; 9(5): 1037-1047
Published online Feb 16, 2021. doi: 10.12998/wjcc.v9.i5.1037
Clinical characteristics of perineal endometriosis: A case series
Yan Liang, Duo Zhang, Ling Jiang, Yuan Liu, Jian Zhang
Yan Liang, Duo Zhang, Jian Zhang, Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, Shanghai 200030, China
Yan Liang, Duo Zhang, Ling Jiang, Yuan Liu, Jian Zhang, Shanghai Key Laboratory Embryo Original Diseases, China
Ling Jiang, Department of Radiology, International Peace Maternity and Child Health Hospital, Shanghai 200030, China
Yuan Liu, Department of Pathology, International Peace Maternity and Child Health Hospital, Shanghai 200030, China
Author contributions: Zhang J developed the study and revised the manuscript; Liang Y was responsible for study development, data collection and manuscript writing; Zhang D analyzed the data and revised the manuscript; Jiang L and Liu Y analyzed the imaging results and histopathologic findings, respectively; and all authors have approved the final version of the manuscript.
Supported by Medical-Engineering Cross Fund from Shanghai Jiaotong University, No. ZH2018QNB17; and National Natural Science Foundation of China, No. 81801400.
Institutional review board statement: This study has been approved by the ethic committee of International Peace Maternity and Child Health Hospital Affiliated to Shanghai Jiaotong University, No. GKLW 2019-08.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: Liang Y and Zhang D have received research funding from the medical-engineering cross fund from Shanghai Jiaotong University, No. ZH2018QNB17; and Natural Science Foundation of China, No. 81801400.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian Zhang, MD, Chief Doctor, Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, No. 910 Hengshan Road, Xuhui District, Shanghai 200030, China. zhangjian_ipmch@sjtu.edu.cn
Received: July 22, 2020
Peer-review started: July 22, 2020
First decision: November 3, 2020
Revised: November 20, 2020
Accepted: December 16, 2020
Article in press: December 16, 2020
Published online: February 16, 2021
Processing time: 190 Days and 20.4 Hours
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.

Keywords: Perineal endometriosis; Incubation period; Pain in the perineum; Surgery; Body mass index; Clinical characteristics

Core Tip: The overall incidence of perineal endometriosis (PEM) is low, accounting for only 0.31% in women with endometriosis treated by surgery. At present, there are few clinical studies on the incidence and clinical characteristics of PEM. This study summarizes the clinical data of 14 PEM cases who visited The International Peace Maternal and Child Health Hospital Affiliated to Shanghai Jiaotong University during the past 11 years. Furthermore, we analyze the incubation period-related factors and pain-related factors of PEM to provide suggestions for the prevention and treatment of PEM.