Iatrogenic endometriosis in parous Slavic woman with history of LASH
Iatrogenic endometriosis is defined as the presence of endometrial glands and stroma out of the uterus because of certain surgical interventions. The rate of iatrogenic endometriosis is after uterine surgeries is 1 to 2%.
This article describes the case of a parous Slavic woman with a history of LASH (a procedure to remove the diseased part of a uterus), 1 year ago because of grade 3 symptomatic apical prolapse. The patient presented to the clinic with a 6-month history of pelvic pain following surgery. The pain aggravated with sexual intercourse and did not alleviate with oral analgesic drug.
Her medical history did not reveal any complaints of urinary incontinence or prolapse. Deep vaginal palpation with a vaginal speculum triggered pain. There were no signs of erosion on the cervix and vaginal wall. Doctors further performed a transvaginal ultrasound which showed a hypoechogenic and hypervascular solid area with irregular contours sized 3 × 2 cm in diameter on the sacral promontory. A transabdominal US was also performed which showed normal kidneys, uterus, and peristalsis.
A flexible cystoscopy with an office-based rectosigmoidoscopy were also advised to rule out reasons for pelvic pain.
There were no other abnormal findings in the bladder and rectosigmoid area. The patient did want to undergo any other diagnostic imaging because of her insurance status.
Doctors discussed the diagnostic possibilities with the patient and scheduled her for a laparoscopy. During surgery, a solid, wine-coloured, hypervascular hemorrhagic lesion was visible macroscopically. The finding was consistent with the diagnosis of endometriosis. There was no sign of invasion of the deeper parts of the organs or pelvic.
The patient was discharged on the first postoperative day. She had an uneventful recovery with no complications. According to the American Society for Reproductive Medicine and category 1, the patient was classified as having stage 1 disease. The patient’s symptoms resoled and no adjuvant treatment was needed for a year after surgery.
References
Iatrogenic endometriosis following apical pelvic organ prolapse surgery: a case report https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-019-2327-x
