1/7. Perineal endometriosis with anal sphincter involvement: report of a case.INTRODUCTION: Perineal endometriosis with anal sphincter involvement is an infrequent occurrence. Wide excision is the best chance of cure of perineal endometriosis but may cause incontinence when the anal sphincter is involved. Conversely, narrow excision may result in incomplete removal, with increased recurrence rates and need of additional therapy. Wide excision with primary sphincteroplasty and narrow excision surgical techniques are reviewed. methods: One case report of perineal endometriosis with anal sphincter involvement and previously reported cases were reviewed. patients were compared based on type of resection (wide or narrow excision) and outcome. RESULTS: Since 1957 there have been seven reported cases of perineal endometriosis with anal sphincter involvement, with the present authors adding one additional case for a total of eight. The mean age was 33 (range, 22-47) years. Surgical treatment included wide excision with primary sphincteroplasty (2 cases), narrow excision (4 cases), and incomplete excision (1 case). One case spontaneously regressed after a subsequent pregnancy. There were two recurrences in the narrow excision group and no recurrences in the wide excision group. There were no complications reported for any of the procedures. CONCLUSIONS: Although follow-up time was variable and the numbers small, wide excision with primary sphincteroplasty for patients with perineal endometriosis with anal sphincter involvement seems to be the best chance of cure with good functional results. It should be considered particularly in younger patients to obviate the need of long-term subsequent hormonal therapy or re-excision for symptomatic recurrences. In contrast, patients closer to menopause (when endometriosis tends to regress) may be treated optimally by narrow excision to avoid the risks of significant anal sphincter resection.- - - - - - - - - - ranking = 1keywords = menopause (Clic here for more details about this article) |
2/7. MRI facilitated a diagnosis of endometriosis of the rectum.A 51-year-old pre-menopausal Japanese woman suffering from chronic lower abdominal pain was referred to our hospital. A barium enema showed a stenotic lesion in the recto-sigmoid region, and a pelvic computed axial tomography (CAT) scan revealed a thickened rectal wall. A colonoscopic examination showed the rectum to be constrictive, but the mucosa appeared to be intact. magnetic resonance imaging (MRI) with T1 high-intensity revealed a cystic lesion in the thickened wall of the rectum, which led us to suspect possible bowel endometriosis. Part of the biopsy specimen showed endometrial epithelium within the interstitial layer of histologically normal mucosa; finally, endometriosis of the rectum was diagnosed. The patient became asymptomatic after the initiation of hormonal treatment and later experienced spontaneous menopause. MRI was effective for diagnosis and the patient did not undergo unnecessary laparotomy. Although bowel endometriosis is generally diagnosed by means of resected specimens, in our patient, diagnosis was made using MRI and biopsy, and hormonal therapy had an effective role as a bridge to menopause.- - - - - - - - - - ranking = 2keywords = menopause (Clic here for more details about this article) |
3/7. endometriosis associated with ureteric obstruction.endometriosis and its complications are not uncommon in Malaysian women. Two cases of ureteric obstruction due to endometriosis are reported and the literature on ureteric obstruction and endometriosis reviewed. It is emphasized that the possibility of ureteric obstruction must be suspected when there is extensive endometriotic disease or if the patient presents with loin pain or pain on one side of the abdomen. Ultrasound scan of the kidneys and, if necessary, an intravenous pyelogram will have to be done on the slightest suspicion. patients with endometriosis will have to be followed up until the menopause or even later if they are on hormone replacement therapy.- - - - - - - - - - ranking = 1keywords = menopause (Clic here for more details about this article) |
4/7. endometriosis of bladder after menopause.We report a rare case of endometriosis of the bladder in a 68-year-old postmenopausal woman. The patient had not received any exogenous estrogen therapy and the hormone levels were normal for a castrated female subject. endometriosis of the bladder should be considered as a cause of an abnormal mass of the bladder even after menopause. This case documents that urinary involvement by endometriosis may persist even after years of a hormonally castrated state.- - - - - - - - - - ranking = 5keywords = menopause (Clic here for more details about this article) |
5/7. Obstructive uropathy associated with endometriosis.Although endometriosis involving the urinary tract is uncommon, it is responsible for considerable morbidity. A review of eight cases at two Ottawa teaching hospitals from 1979 to 1983 revealed obstructive uropathy in seven patients. There was permanent loss of kidney function in two, ovarian remnant syndrome in two, and patient and family history of renal disease in three. The diagnosis of endometriosis was not made before operation in four patients. endometriosis was localized in four patients and generalized in the remaining four, while four patients had significant uterosacral nodularity. The conclusion reached after study of this small but important population is that physicians should have a heightened awareness of this uncommon but serious manifestation of the disease. Earlier diagnosis might be achieved on the basis of a high index of suspicion and careful physical and pelvic examination. The liberal use of intravenous pyelography even in cases of minimal endometriosis is urged. Intensive and prolonged follow-up of all patients with the diagnosis of endometriosis is recommended until the menopause has been reached. Treatment of obstructive uropathy requires meticulous surgical intervention and we recommend ovarian ablation with adjuvant hormonal therapy in most circumstances.- - - - - - - - - - ranking = 1keywords = menopause (Clic here for more details about this article) |
6/7. Postmenopausal ureteral endometriosis with atypical adenomatous hyperplasia following hysterectomy, bilateral oophorectomy, and long-term estrogen therapy.endometriosis of the ureter is rare. The authors describe a case of ureteral endometriosis presumed on clinical and radiologic grounds to be a primary ureteral malignancy. The unique feature of the present case is the development, after long-term estrogen therapy, of postmenopausal ureteral endometriosis with extensive atypical adenomatous hyperplasia. The present case demonstrates that reactivation of endometriosis and the development of atypical hyperplasia may occur after menopause with prolonged estrogen therapy.- - - - - - - - - - ranking = 1keywords = menopause (Clic here for more details about this article) |
7/7. A case of ovarian endometriosis in late post-menopause.We describe a case of ovarian endometriosis in a 67 years old woman admitted to our hospital. After clinical examination and instrumental investigation, we opted for surgical operation including bilateral ovarosalpingolisis, bilateral hysteroannexectomy and appendectomy.- - - - - - - - - - ranking = 4keywords = menopause (Clic here for more details about this article) |