The clinical features and management of perineal endometriosis with anal sphincter involvement: a clinical analysis of 31 cases

Abstract

The aim of this study was to investigate the appropriate measures for diagnosing and treating perineal endometriosis (PEM) with anal sphincter involvement. methods: Between January 1992 and April 2011, the clinical features, diagnosis and management of 31 patients who were diagnosed with PEM with anal sphincter involvement at the Peking Union Medical College Hospital were retrospectively analyzed using their clinical records. A range of 6-78 months of outpatient follow-up after surgery were conducted for these 31 patients but was extended by telephone interviews with 29 patients conducted in December 2011. results: All 31 patients had a history of vaginal delivery. The level of serum CA 125 was elevated in only 2 (6.5%) cases. All cases received surgical treatment, which included narrow excision (NE, close to the edge of the endometrioma) with primary sphincteroplasty (PSp) for 30 cases and incomplete excision (IE) for 1 case. Of the 30 cases in the NE group, 20 (66.7%) received hormone therapy preoperatively. Up until December 2011, there was one recurrence (3.6%) of PEM in the NE group. PEM relapse occurred in the IE patient 6 years after the initial IE surgery. Perineal abscesses were found in one patient post-operatively. No complaint of dyspareunia and no fecal incontinence episodes were observed during follow-up. conclusions: Based on our own experience, NE and PSp may be indicated for the treatment of PEM with anal sphincter involvement.

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

“…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.…”

Perineal Endometriosis: What to Do in These Cases - Analysis of 13 Patients

“…Our study is the only one in the literature that evaluates pre-and post-surgical anal continence in this entity using a scale, showing no changes in this parameter in a long follow-up; also there is no consensus in the literature about the advantages when pre-operative medical therapy is given and not given. However, like in the study of Na Chen et al, we recommend the use of preoperative hormone therapy and the reasons are as follows: preoperative hormone therapy could reduce the size of the endometrioma and make the boundaries of these lesions clearer, thus facilitating the complete excision of the lesions and reducing damage to surrounding tissues [17]; we also decided to administer to all patients after surgery a high dose of progestin based on norethindrone acetate 5 mg daily for 6 months with the intention of reducing local recurrence, which in our series has been nil; this is in contrast with the variability rate of recurrence reported in other studies [3].…”

A Case of Endometriosis in Episiotomy Scar with Anal Sphincter Involvement and Extension into Ischiorectal Fossa

“…In nearly half of women with PEM, the lesions erode into anal sphincter. 6 Thus, it is imperative that further examination (including DRE and endoanal ultrasonography) should be used to confirm whether the anal sphincter is involved in a patient with PEM. Physical examination (including DRE) could provide extremely important additional clues.…”