We report the case of a 29‐year‐old woman with deep infiltrating endometriosis who underwent robotic nerve‐sparing surgery for resection of all visible lesions infiltrating pelvic and extrapelvic sites. Painful symptoms included severe dysmenorrhea, menstrual dyschezia and stranguria, with no improvement in response to hormonal treatment. The location on physical examination of a painful retrocervical nodule was identified by magnetic resonance imaging to be infiltrating the right parametrium/paracervix. During surgery, this nodule was recognized as an important retrocervical/rectovaginal lesion infiltrating the pelvic floor (i.e. levator ani and coccygeus), and was histopathologically confirmed as endometriosis infiltrating the skeletal pelvic floor muscles. A Pubmed search of the MEDLINE database in March (2019) found no publication reporting histopathologic confirmation of endometriosis infiltrating the pelvic floor muscles.

Background and Objectives: Based on laparoscopic views, we hypothesized that the involvement of the lateral compartment of the pelvis (LCP) by deep infiltrating endometriosis can be inferred by observing retraction of the obliterated umbilical artery (OUA) toward the abdominal cavity. We sought to verify the association between the retraction of the OUA and the presence of endometriosis in the ipsilateral LCP (parametrium, paracervix, or paracolpium). Methods: This preplanned, retrospective, cross-sectional study evaluated 76 women with deep endometriosis at a private referral center. Using magnetic resonance imaging, the retraction of OUA was represented by its distance from the rectus abdominis (four different measurements were used). The diameter of the OUA was also measured and considered. T2-weighted imaging of the pelvis were obtained in two planes (sagittal and axial) and from two reference points: the proximal angle of the artery (measurement 1) and a point immediately above (measurement 2). The measurements were assessed through an exploratory multivariate principal component analysis. The associations were tested using the bivariate, non-parametric statistical Mann-Whitney U test. Results: The presence of endometriosis of all LCP examined was 34.2% (95% confidence interval: 26.8–41.7) with the highest percentage in the paracervix. The retraction of the OUA was greater in women with endometriosis in the ipsilateral LCP for all four measurements and was statistically significant for three of them: Sagittal 1 (p = .011), Sagittal 2 (p = .015), Axial 1 (p = .021), and Axial 2 (p = .093). The OUA diameter was not associated with its retraction (p = .392). Conclusion: Retraction of the OUA toward the abdominal cavity is associated with the presence of endometriosis in the ipsilateral paracervix.

Introduction. Large resections may be necessary in cytoreductive surgery for endometriosis, which present risk of urinary and bowel complications. Presentation of Case. A 29-year-old woman underwent multidisciplinary laparoscopy for endometriosis in a private practice setting for acyclic pelvic pain and cyclic abdominal distension with changes in bowel habits and frequent sensation of incomplete defecation. After surgery, urodynamics remained normal and bowel function improved subjectively and objectively per dynamic magnetic resonance defecography (DMRD). The five-month follow-up found improvements in pain scores, bowel function, and health-related quality of life (assessed by the full versions of the Short Form 36 and Endometriosis Health Profile 30 scales). Discussion. Animus may contribute to the bowel symptoms in women with endometriosis. DMRD provides additional objective parameters for comparing pre- and postoperative functions. Conclusion. A nerve-sparing segmental rectosigmoidectomy for endometriosis carefully executed by a multidisciplinary team can preserve the function of different pelvic organs.