Presumption of pericardial endometriosis using MRI: Case report and review of the literature

A Case of Rectal Endometriosis Misdiagnosed as Rectal Malignancy on Three Colonoscopies and Biopsies Sharing a Combined Literature Review

Background

Endometriosis involves the intestine, and its clinical manifestations are nonspecific and lack of etiological manifestations. The diagnosis is difficult, which often leads to misdiagnosis. We report a case of endometriosis which was misdiagnosed as intestinal malignant tumor after colonoscopy and three biopsies.

Case Presentation

We reported a 42-year-old woman who went to see a doctor because of anal distension. She was examined by three gastrointestinal endoscopists at different levels in different hospitals and underwent biopsy at the same time. Combined with clinical manifestations, imaging examination, endoscopic examination and pathological examination, she was misdiagnosed as intestinal malignant tumor, and partial intestinal resection was performed according to the surgical principle of malignant tumor.

Conclusion

Although there are advanced gastrointestinal endoscopy and imaging techniques, intestinal endometriosis is still easy to be misdiagnosed. As our case report shows, after three colonoscopy and biopsy, it is still misdiagnosed as intestinal malignant tumor. Further research is needed to improve the ability of preoperative diagnosis, which deserves the attention of gastroenterologists and obstetricians and gynecologists.

Laparoscopic excision of pericardial and diaphragmatic endometriosis

OBJECTIVE

To present a five-step approach to the laparoscopic excision of pericardial and diaphragmatic endometriosis.

DESIGN

Surgical video.

SETTING

Academic tertiary care hospital.

PATIENT(S)

35-year-old nulliparous woman observed for chronic pelvic pain and infertility with a diagnosis of diaphragmatic endometriosis at a prior laparoscopy. Symptoms included severe chest pain and right shoulder tip pain, refractory to multiple medical therapies.

INTERVENTION(S)

Laparoscopic excision of pericardial and diaphragmatic endometriosis.

MAIN OUTCOME MEASURE(S)

Description of the relevant anatomy, the literature surrounding pericardial and diaphragmatic endometriosis, and the approach to the surgical intervention and postoperative care.

RESULT(S)

The laparoscopic excision of the full-thickness pericardial and diaphragmatic endometriotic lesions was successfully completed according to five reproducible steps: upper abdominal survey, liver mobilization, excision of diaphragmatic endometriosis, intrathoracic laparoscopic exploration, and closure of the diaphragmatic defect.

CONCLUSION(S)

Although rare and challenging to diagnose and treat, pericardial and diaphragmatic endometriosis and its potentially debilitating symptoms can be successfully managed through a multidisciplinary and stepwise surgical intervention.

An asymptomatic anterior vaginal wall endometrioma, a rare manifestation of endometriosis: A case report

A 23-year-old patient with an asymptomatic anterior vaginal wall cyst was referred to gynecology for evaluation and treatment. Preoperative assessment with physical examination and magnetic resonance (MR) imaging of the pelvis was most consistent with Gartner’s cyst. Following resection of the cyst wall, histologic evaluation demonstrated endometrial glands, hemosiderin-laden macrophages and inflammation, consistent with vaginal wall endometrioma. This case highlights challenges in the diagnosis of endometriosis in the vagina and in other rare locations, possible mechanisms of development, and proposed treatments.

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Endometriosis implants can occur widely throughout the body, but rarely in the vagina.

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Endometrioma is an atypical etiology of a vaginal lesion, and can be asymptomatic.

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Preoperative magnetic resonance imaging and histologic evaluation are helpful to characterize the lesion.

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Treatment of vaginal endometrioma is with surgical excision of the cyst wall, and recurrence is unlikely.