臍部と卵巣の子宮内膜症併存例に対し気腹法による付属器切除と臍形成術を施行した１例

Abstract

We report a case in which umbilical endometriosis was resected and the umbilicus was used as an insufflation port for laparoscopic right adnexectomy before umbilicoplasty.A 47-year-old gravida-2 para-2 woman, with no significant surgical history, presented with umbilical pain coinciding with her menstrual cycle for the last two years. She consulted the Department of Dermatology in our hospital. She underwent a biopsy of an umbilical mass, which was diagnosed as endometriosis, and was referred to the Department of Gynecology. We decided to resect the umbilical endometriosis and perform umbilicoplasty. Furthermore, we conducted additional laparoscopic resection of any endometriosis lesions identified in the abdominal cavity. A 20-mm, clearly demarcated mass was resected from the umbilicus. A 12-mm balloon trocar was placed in the umbilicus. However, air leakage necessitated the use of LAP DISC mini Ⓡ to maintain abdominal insufflation. Intraperitoneal observation revealed that one-third of the right ovary was tightly adhered to the pelvic wall. Thus, a three-port laparoscopic right adnexectomy was performed. After adnexectomy, a plastic surgeon carried out umbilicoplasty during the same surgical intervention.In a single surgery, the umbilical mass was excised, umbilicoplasty was performed, and a laparoscopic right adnexectomy was conducted in collaboration with a plastic surgeon. Patients with umbilical endometriosis may have concomitant ovarian endometriosis, even if no enlargement of the adnexa is identified preoperatively. Modifying the abdominal insufflation procedure can enable laparoscopic observation and lesion resection in addition to treatment of the umbilical lesion.