Characteristics and long-term outcomes of perineal endometriosis

Liu, Yu; Pi, Ruyu; Luo, Hong; Wang, Wei; Zhao, Xia; Qi, Xiaorong

doi:10.1097/md.0000000000020638

Cited by 6 publications

(16 citation statements)

References 15 publications

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“…Ninety articles published between 1956 and 2020 were eventually included in our review. Eighty-three articles were case reports or case series including one to eight patients (2,9,11, and seven studies described retrospective cohorts of 14-36 patients (10,(91)(92)(93)(94)(95)(96). The main results of the eight retrospectives studies can be found in Table 2.…”

Section: Resultsmentioning

confidence: 99%

“…Work-up for vulvo-perineal endometriosis.CA 125, cancer Antigen 125; MRI, magnetic resonance imaging; CT-scan, Computerized Tomography scan; FNAC, fine needle aspiration cytology. levels of CA125 were found in 6.5-46.7% of patients with perineal endometriosis(10,93,94,96). Pelvic ultrasound was mostly performed to exclude pelvic endometriosis.…”

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confidence: 99%

“…Pelvic ultrasound was mostly performed to exclude pelvic endometriosis. Perineal and endoanal ultrasound(50,93,94,96), as well as magnetic resonance imaging (MRI)…”

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Diagnosis and Treatment of Vulvo-Perineal Endometriosis: A Systematic Review

et al. 2021

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Objective: To describe the available knowledge on vulvo-perineal endometriosis including its diagnosis, clinical management and recurrence rate.Methods: We followed the PRISMA guidelines for Systematic Reviews and our study was prospectively registered with PROSPERO (CRD42020202441). The terms “Endometriosis” and “Perineum” or “Vulva” were used as keywords. Cochrane Library, Medline/Pubmed, Embase and Clinicaltrials.gov were searched. Papers in English, Spanish, Portuguese, French or Italian from inception to July 30, 2020 were considered. Reference lists of included articles and other literature source such as Google Scholar were also manually scrutinized in order to identify other relevant studies. Two independent reviewers screened potentially eligible studies according to inclusion criteria.Results: Out of 539 reports, 90 studies were eligible including a total of 283 patients. Their mean age was 32.7 ± 7.6 years. Two hundred sixty-three (95.3%) presenting with vulvo-perineal endometriosis have undergone either episiotomy, perineal trauma or vaginal injury or surgery. Only 13 patients (4.7%) developed vulvo-vaginal endometriosis spontaneously i.e., without any apparent condition favoring it. The reasons that motivated the patients to take medical advice were vulvo-perineal cyclical pain increasing during menstruations (98.2% of the patients, n = 278). Out of the 281 patients for whom a clinical examination was described, 274 patients (97.5%) showed a vulvo-perineal nodule, mass or swelling while six presented with bluish cutaneous lesions (2.1%) and 1 with bilateral polyps of the labia minora (0.4%). All but one patients underwent surgical excision of their lesions but only 88 patients (28.1%) received additional hormonal therapy. The recurrence rate was 10.2% (29 patients) considering a median follow-up period of 10 months (based on 61 studies).Conclusion: In conclusion, vulvo-perineal endometriosis is a rare entity with approximately 300 cases reported in the literature since 1923. With the available knowledge shown in this systematic review, we encourage all practitioners to think about perineal endometriosis in case of perineal cyclical pain with or without previous perineal damage. Diagnosis should be done with clinical exam, perineal ultrasound and pelvic MRI when available. In case of anal sphincter involvement, perianal ultrasound should be performed. Surgical excision of the lesion should be realized in order to remove the lesion and to confirm the diagnosis histologically. Hormonal treatment could be proposed to attempt to decrease the size of a large lesion before surgery or to avoid recurrence of the lesion. As evidence-based approach to the diagnosis, treatment and recurrence rate of affected patients remains a challenge given its low prevalence, the variations in management found in the articles included and the limited quality of available studies, we suggest that a prospective database on vulvo-perineal endometriosis should be generated to increase knowledge but also awareness among healthcare professionals and optimize patients' care.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, identifier: CRD42020202441.

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Section: Resultsmentioning

confidence: 99%

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Diagnosis and Treatment of Vulvo-Perineal Endometriosis: A Systematic Review

et al. 2021

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“…Schikele was the first to address the issue in 1923, but since then, there still are very few studies in the literature worldwide covering this disease. Perineal endometriosis is defined by the presence of endometrial cells in the perineum [ 4 ]. It usually affects women who have an old episiotomy scar, an obstetric tear or even a caesarean scar in their medical history.…”

Section: Introductionmentioning

confidence: 99%

“…The pathogenesis of perineal endometriosis is still not clearly established despite the many theories surrounding the matter. The most approved theory is direct implantation of the endometrial cells on scars during the obstetric trauma [ 4 ]. Complementary exams are usually prescribed, but the diagnosis can only be confirmed after histopathological examination of the material [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Perineal endometriosis: a rare case of a unique sizeable nodule: a case report

Hakim¹,

Halima²,

Zouari³

et al. 2021

Pan Afr Med J

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Endometriosis is the presence of endometrial tissue in abnormal locations outside the uterine cavity. These locations are usually the ovaries, the peritoneum, and the uterine ligaments. Less frequently, the endometrial tissue can affect the perineum especially after surgical procedures or obstetric lesions. In this case report, we describe the case of a patient suffering from pain and swelling, with a sizeable nodule in an old episiotomy scar. Clinical examination, ultrasonography (USG) and magnetic resonance imaging (MRI) helped evoke the diagnosis of perineal endometriosis, and there were no signs of other endometriosis locations. Hormonal treatment was provided at first, but there was no clinical improvement after three months, so the treatment had to be surgical. Histopathological examination of the endometriotic mass confirmed the diagnosis. There were no immediate postoperative complications, and no clinical symptoms or recurrence signs six months and one year after.

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