Multidisciplinary surgical management of severe posterior compartment endometriosis

Abstract

Background Endometriosis is a chronic, infammatory, and hormone-dependent disease that afects approximately 10% of women in reproductive age. Endometriosis is categorized into diferent types, as superfcial, deep, and ovarian endometriosis. When deep endometriosis occurs, the sigmoid and rectum are often afected (Becker et al. in Hum Reprod Open, 2022, https://doi.org/10.1093/hropen/hoac009). In the following article, we aim to demonstrate stepwise surgery for stage IV endometriosis involving the anterior rectosigmoid. Methods We present the case of a 26-year-old obese (BMI 35.87) woman with severe posterior pelvic compartment endometriosis, persistent abdominal pain, and constipation. On preoperative MRI of the pelvis, a 13 cm conglomerate incorporating both ovaries (kissing ovaries), uterine serosa, and the anterior rectosigmoid was observed (Fig. 1). Accordingly, interdisciplinary laparoscopic surgery with a gynecologist and colorectal surgeon was planned. Results The total laparoscopic approach is demonstrated step by step in the video. Conclusions Deep endometriosis is a rare condition. When involvement of other organs (e.g., the bowel) is suspected, preoperative endometriosis-specifc imaging should be performed for optimal surgical planning. Experienced endometriosis multidisciplinary surgical teams can provide specialized and high-quality care for patients sufering from this debilitating disease (Luna Russo et al. in Minerva Ginecol, 2020, https://doi.org/10.23736/S0026-4784.20.04544-X).