Deep pelvic endometriosis

Case contributed by Dr Utkarsh Kabra

Presentation

Severe dysmenorrhoea.

Patient Data

Age: 40 years
Gender: Female
MRI

Bulky retroverted uterus with LSCS scar in the lower anterior uterine wall showing foci of old hemorrhage. Multiple foci of hemorrhage are also seen along the anterior pelvic wall at the previous incision site.

There is significant thickening of endo-myometrial junctional zone, predominantly in posterior uterine wall and measures approx. 22mm in maximum thickness.

Lobulated cystic lesions are seen in the left adnexal region with an inseparable left ovary. Cystic lesions are seen containing hemorrhagic fluid and fluid-fluid levels. 

Small cystic lesion containing hemorrhagic products is seen in the right ovary.

Multiple hemorrhagic foci are seen in bilateral adnexal regions, along the posterior surface of the uterus with fibrotic bands/adhesions extending into bilateral adnexal and anterior perirectal regions, involving the rectal wall and causing its distortion. There is increased parametrial vascularity. 

Subserosal fibroid is seen along the anterior uterine wall.

Few nabothian cysts are seen in the cervix.

Case Discussion

Hemorrhagic cystic lesions in the adnexae with multiple hemorrhagic foci along the posterior surface of the uterus, fibrotic bands/adhesions extending into bilateral adnexal and anterior perirectal regions, involving the rectal wall and causing its distortion suggests the possibility of deep pelvic endometriosis.

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Case information

rID: 70296
Published: 13th Aug 2019
Last edited: 16th Aug 2019
System: Gynaecology
Inclusion in quiz mode: Included
Institution: Getwell Poly Clinic & Hospital

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