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Chase DM, McCann LD, Treuth A, Cui H, Laniewski P, Jimenez NR, Mahnert ND, Roe DJ, Herbst-Kralovetz MM. Preoperative quality of life at time of gynecologic surgery: considerations for postoperative management. AJOG GLOBAL REPORTS 2023; 3:100275. [PMID: 38077226 PMCID: PMC10701442 DOI: 10.1016/j.xagr.2023.100275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Patients presenting for gynecologic surgery are a heterogeneous group. Preoperative quality of life may be a useful tool to guide postoperative management. OBJECTIVE This study aimed to examine the key drivers of preoperative quality of life to improve counseling and postoperative management. STUDY DESIGN This study analyzed preoperative survey results from 154 participants using the following surveys: National Institutes of Health Toolbox Global Health v1.2, Gastrointestinal: Gas and Bloating v1.1 13a, Gastrointestinal: Diarrhea v1.0 6a, and Sexual Function and Satisfaction Brief Profile (Female) v2.0, Perceived Stress Scale, the Vaginal Assessment Scale, and the Vulvar Assessment Scale. Survey results in the form of T-scores were compared in patients with endometrial cancer and patients with benign gynecologic conditions using the Kruskal-Wallis test. The multivariate analysis was performed using linear regression to adjust the comparisons for age, body mass index, and comorbidity. RESULTS Of the 154 patients, preoperative diagnosis was benign in 66% (n=102) and endometrial cancer in 34% (n=52). Patients with endometrial cancer were more likely to be older, non-White, in lower income brackets, have higher body mass index, and be postmenopausal (P<.05). Although preoperative global health scores were similar between benign and malignant cases (P>.05), when adjusted for age, the differences in global health quality of life between patients with benign gynecologic conditions and those with endometrial cancer became significant, because the endometrial cancer group was older than the benign group (P<.05). However, when adjusting for age, body mass index, and comorbidities (hypertension and diabetes), the differences were no longer significant (P>.05). Sexual interest was decreased in the patients with endometrial cancer both in the unadjusted and adjusted model; and vulvar complaints became significantly different between the groups when controlling for body mass index, age, and comorbidities (P<.05). CONCLUSION Despite substantial differences in preoperative diagnosis, preoperative quality of life is highly influenced by age, body mass index, and comorbidities. Therefore, these factors should be explored in surgical outcomes and postoperative management trials.
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Affiliation(s)
- Dana M. Chase
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA (Dr Chase)
| | - Lelan D. McCann
- Department of Obstetrics and Gynecology, College of Medicine-Phoenix, The University of Arizona, Banner University Medical Center Phoenix, Phoenix, AZ (Drs McCann, Mahnert, and Herbst-Kralovetz)
| | - Alice Treuth
- Department of Basic Medical Sciences, College of Medicine-Phoenix, The University of Arizona, Phoenix, AZ (Ms Treuth and Drs Laniewski, Jimenez, and Herbst-Kralovetz)
| | - Haiyan Cui
- University of Arizona Cancer Center, Tucson, AZ (Drs Cui and Roe)
| | - Pawel Laniewski
- Department of Basic Medical Sciences, College of Medicine-Phoenix, The University of Arizona, Phoenix, AZ (Ms Treuth and Drs Laniewski, Jimenez, and Herbst-Kralovetz)
| | - Nicole R. Jimenez
- Department of Basic Medical Sciences, College of Medicine-Phoenix, The University of Arizona, Phoenix, AZ (Ms Treuth and Drs Laniewski, Jimenez, and Herbst-Kralovetz)
| | - Nicole D. Mahnert
- Department of Obstetrics and Gynecology, College of Medicine-Phoenix, The University of Arizona, Banner University Medical Center Phoenix, Phoenix, AZ (Drs McCann, Mahnert, and Herbst-Kralovetz)
| | - Denise J. Roe
- University of Arizona Cancer Center, Tucson, AZ (Drs Cui and Roe)
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ (Dr Roe)
| | - Melissa M. Herbst-Kralovetz
- Department of Obstetrics and Gynecology, College of Medicine-Phoenix, The University of Arizona, Banner University Medical Center Phoenix, Phoenix, AZ (Drs McCann, Mahnert, and Herbst-Kralovetz)
- Department of Basic Medical Sciences, College of Medicine-Phoenix, The University of Arizona, Phoenix, AZ (Ms Treuth and Drs Laniewski, Jimenez, and Herbst-Kralovetz)
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Chiu T, Niranjan N, FitzGerald K. Endometrioma causing recurrent small bowel obstruction in a virgin abdomen-a case report and literature review. J Surg Case Rep 2023; 2023:rjad392. [PMID: 37416495 PMCID: PMC10319765 DOI: 10.1093/jscr/rjad392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/17/2023] [Indexed: 07/08/2023] Open
Abstract
There has been a modest number of cases of bowel obstruction secondary to endometriosis reported. Delays in diagnoses can cause significant morbidity to patients. We describe the case of a 45-year-old female with a 2-year history of recurrent small bowel obstructions (SBOs) without a history of abdominal surgery. She underwent multiple computed tomography scans, and a magnetic resonance enterography, which queried possible terminal ileitis secondary to Crohn's fibro-stenosing disease or a Meckel's diverticulum. Colonoscopy up to TI was normal. Elective laparoscopy showed a cicatrizing small bowel mass in her distal ileum ~15 cm from the TI, which was resected. There were no other findings. Histopathological testing revealed endometriosis. At 2-month post-resection, she remains symptom-free and was referred to gynaecology. Endometriosis causing bowel obstruction should be considered early in female patients, especially those with virgin abdomens. Timely elective laparoscopy is a safe and effective way of diagnosing and treating small bowel obstruction, avoiding an emergency procedure.
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Affiliation(s)
- Tricia Chiu
- Correspondence address. Department of General Surgery, Wagga Wagga Base Hospital, Docker Street Wagga Wagga, NSW 2650, Australia. Tel: +61 (02) 5943 1000; E-mail:
| | - Nithya Niranjan
- Department of Surgery, Wagga Wagga Base Hospital, Docker St Wagga Wagga, NSW 2650, Australia
| | - Kate FitzGerald
- Department of Surgery, Wagga Wagga Base Hospital, Docker St Wagga Wagga, NSW 2650, Australia
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Coutureau J, Mandoul C, Verheyden C, Millet I, Taourel P. Acute abdominal pain in women of reproductive age: keys to suggest a complication of endometriosis. Insights Imaging 2023; 14:94. [PMID: 37222834 DOI: 10.1186/s13244-023-01433-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/08/2023] [Indexed: 05/25/2023] Open
Abstract
Although endometriosis is a common gynecological condition in women of reproductive age, a complication of endometriosis is rarely considered as the differential diagnosis of acute abdominal pain in that context. However, acute events in women with endometriosis can represent life-threatening conditions, which require emergent treatment and often surgical management. Mass effect of endometriotic implants can give rise to obstructive complications, specifically occurring in the bowel or in the urinary tract, while inflammatory mediators released by ectopic endometrial tissue can lead to inflammation of the surrounding tissues or to superinfection of the endometriotic implants. Magnetic resonance imaging is the best imaging modality to reach the diagnosis of endometriosis, but an accurate diagnosis is possible on computed tomography, especially in the presence of stellar, mildly enhanced, infiltrative lesions in suggestive areas. The aim of this pictorial review is to provide an image-based overview of key findings for the diagnosis of acute abdominal complications of endometriosis.
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Affiliation(s)
- Juliette Coutureau
- Department of Medical Imaging, CHU Lapeyronie, Universitary Hospital of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France.
| | - Caroline Mandoul
- Department of Medical Imaging, CHU Lapeyronie, Universitary Hospital of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France
| | - Cecile Verheyden
- Department of Medical Imaging, CHU Lapeyronie, Universitary Hospital of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France
| | - Ingrid Millet
- Department of Medical Imaging, CHU Lapeyronie, Universitary Hospital of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France
| | - Patrice Taourel
- Department of Medical Imaging, CHU Lapeyronie, Universitary Hospital of Montpellier, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France
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Huang KG, Lee CL, Khoo B. From radical hysterectomy to radical surgery for deep endometriosis. Gynecol Minim Invasive Ther 2023; 12:1-3. [PMID: 37025439 PMCID: PMC10071867 DOI: 10.4103/gmit.gmit_140_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 12/28/2022] [Accepted: 01/06/2023] [Indexed: 02/11/2023] Open
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Lukac S, Schmid M, Pfister K, Janni W, Schäffler H, Dayan D. Extragenital Endometriosis in the Differential Diagnosis of Non- Gynecological Diseases. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:361-367. [PMID: 35477509 PMCID: PMC9472266 DOI: 10.3238/arztebl.m2022.0176] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/02/2021] [Accepted: 03/30/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Endometriosis is a chronic, benign disease that affects approximately 10% of women of childbearing age. Its characteristic clinical features are dysmenorrhea, dyschezia, dysuria, dyspareunia, and infertility. The manifestations of extragenital endometriosis (EE) are a diagnostic challenge, as this disease can mimic other diseases due to its unusual location with infiltration of various organs and corresponding symptoms. METHODS This review is based on publications retrieved by a selective search of the literature on the commonest extragenital sites of endometriosis, including the relevant current guideline. RESULTS Current evidence on the treatment of extragenital endometriosis consists largely of cohort studies and cross-sectional studies. The treatment is either surgical and/or conservative (e.g., hormonal therapy). Gastrointestinal endometriosis is the most common form of EE, affecting the rectum and sigmoid colon in nearly 90% of cases and typically presenting with dyschezia. Urogenital endometriosis is the second most common form of EE. It affects the bladder in more than 85% of cases and may present with dysuria, hematuria, or irritable bladder syndrome. The diaphragm is the most common site of thoracic endometri - osis, potentially presenting with period-associated shoulder pain or catamenial pneumothorax. Endometriosis affecting a nerve often presents with sciatica. In abdominal wall endometriosis, painful nodules arise in scars from prior abdominal surgery. CONCLUSION There is, as yet, no causally directed treatment for chronic endometriosis. The treatment is decided upon individually in discussion with the patient, in consideration of risk factors and after assessment of the benefits and risks. Timely diagnosis is essential.
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Affiliation(s)
- Stefan Lukac
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Marinus Schmid
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Kerstin Pfister
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Henning Schäffler
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Davut Dayan
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
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