L’endométriose périnéale profonde sur cicatrice d’épisiotomie: à propos d’un cas rare

Laadioui, Meriem; Alaoui, Fatimazahra Fdili; Jayi, Sofia; Bouguern, Hakima; Chaara, Hikmat; Melhouf, Moulay Aabdelilah

doi:10.11604/pamj.2013.16.112.3415

Cited by 5 publications

(6 citation statements)

References 7 publications

(10 reference statements)

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“…The differential diagnosis in such patients includes, but is not limited to, anal fistula, abscesses, suture granulomas, Bartholin cysts or bartholinitis, hernias, hematoma, sebaceous cyst, lipoma, herpes, neoplastic tissue or metastatic carcinoma, traumatic neuroma, desmoid tumor and anal melanoma ( 9 , 28 , 42 , 45 , 46 ). A perineal mass discovered in menopaused women should be considered as malignant until proven otherwise.…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…Anal melanoma should also be evoked despite its rareness [ 6 ]. The two imaging exams that are usually performed to help confirm the diagnosis of endometriosis are ultrasonography and magnetic resonance imaging [ 7 ]. Sonographic findings are not specific, and a heterogeneous hypoechoic lesion with internal echoes is the most common feature in perineal endometriosis [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…Sonographic findings are not specific, and a heterogeneous hypoechoic lesion with internal echoes is the most common feature in perineal endometriosis [ 5 ]. Magnetic resonance imaging is now considered the best imaging technique to assess endometriosis [ 7 ]. It can be useful in analyzing pelvic and extra pelvic locations and detecting other implantation sites, even distant ones, but its input is much more significant with deep pelvic endometriosis [ 8 ].…”

Section: Discussionmentioning

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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“…2 Perineal endometriosis was first reported in 1923 Scheckele, and first case of ano-perineal endometriosis of anal canal by De La Cruz in 1968. 3 The etiology and pathogenesis of endometriosis are complex and still incompletely understood.…”

Section: Discussionmentioning

confidence: 99%

A rare case of perineal endometriosis with anal sphincter involvement

Bhadana¹,

Kiran²,

Malla³

2020

Int J Reprod Contracept Obstet Gynecol

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Perineal endometriosis is a rare entity which can be explained by direct implantation of endometriotic cells over the fresh episiotomy wound and subsequent development of scar endometriosis. Perineal scar endometriosis incidence is reported to be 0.3% to 1%. 28 years old, P1L1, presented with pain and swelling near episiotomy site which is associated with menstruation. Examination during menstruation revealed swelling was tender, erythematous and slightly increased in size. Clinical diagnosis of scar endometriosis was made after clinical examination. Mass excised and sent for histopathological examination. Although diagnosis essentially remains clinical, preoperative evaluation with perineal ultrasound and MRI was performed. Wide local excision remains treatment of choice and follow up for recurrence is recommended. Histopathological examination is obligatory to exclude rare possibility of malignant changes.

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L’endométriose périnéale profonde sur cicatrice d’épisiotomie: à propos d’un cas rare

Cited by 5 publications

References 7 publications

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

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

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

A rare case of perineal endometriosis with anal sphincter involvement

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