Anal Endosonography in the Diagnosis and Management of Perianal Endometriosis: Report of a Case

Watanabe, Makoto; Kamiyama, Goichi; Yamazaki, Katsuo; Hiratsuka, Kenshi; Takata, Makoto; Tsunoda, Akira; Shibusawa, Miki; Kusano, Mitsuo

doi:10.1007/s00595-003-2545-z

Cited by 19 publications

(4 citation statements)

References 5 publications

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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%

“…With regard to perineal ultrasonography, variable sonographic features were seen, as it is the case for abdominal wall endometriosis, which could make the diagnostic process more challenging but it remains useful to describe precisely the size of the lesions and to assess the extent of the ASI. Preoperative endoanal ultrasonography has also been described as a reliable technique for visualizing perianal endometriosis and diagnosing ASI, enabling the surgeon to determine the extent of an operative procedure and the possible need for a sphincteroplasty ( 46 , 86 ). Ultrasonographic features of the lesion are usually similar to those observed with perineal ultrasonography with the advantage that it better reveals the involvement of the anal sphincter ( 10 ).…”

Section: Discussionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…Le traitement de choix est la résection chirurgicale à adapter dans ses modalités selon l'âge des patientes [8]. Elle peut être réalisée sous anesthésie locale [9], locorégionale ou générale [8], selon la taille du nodule.…”

Section: Discussionunclassified

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

Laadioui¹,

Alaoui²,

Jayi³

et al. 2013

Pan Afr Med J

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Parmi les localisations rares de l'endométriose sur cicatrice, celle du périnée demeure exceptionnelle, l'origine en est souvent iatrogène (épisiotomie). Nous rapportons le cas d'une patiente présentant une douleur cyclique, au niveau de la cicatrice d’épisiotomie. Avec à l'examen clinique une masse de 3,5 cm de grand diamètre au niveau de la cicatrice d’épisiotomie. L’écho périnéale a objectivé une image hypoéchgène hétérogène non vascularisée en regard de la cicatrice d’épisiotomie faisant 3,23/1cm. L'excision de la lésion a été réalisée et l’étude anatomopathologique a confirmé le diagnostic d'endométriose. Les suites postopératoires étaient simples avec un recul de 3 mois sans récidive de la douleur ni de la masse. A travers notre cas et une revue de la littérature, nous insistons sur les la nécessité du diagnostic clinique et d'une prise en charge précoce en vue d'améliorer le pronostic de cette entité rare.

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“…Fine needle aspiration cytology has been shown to be helpful in diagnosis [4]. Anal endosonography can help to know the precise anatomical location and involvement of the external anal sphincter [5]. Involvement of senior surgeons and biopsy of unusual lesions in patients presenting with symptoms of recurrent perianal pain would establish the diagnosis early.…”

Section: Discussionmentioning

confidence: 99%

Perianal Endometriosis Mimicking Recurrent Perianal Abscess

Iqbal

Thumbe

Dhange

et al. 2009

Case Rep Gastroenterol

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Endometriosis of the perianal region is an extremely rare condition usually seen in episiotomy scars and can involve the septum separating vagina and anal canal. The clinician is unlikely to suspect it if there is no scar in the perineum and patient the does not give a history of episiotomy. Moreover it is difficult to suspect when the patient does not report cyclical pain and therefore it is likely to be treated as perianal sepsis. We report the rare case of a 35-year-old woman who presented with recurrent painful nodule of endometriosis of the perianal area without previous episiotomy.

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Anal Endosonography in the Diagnosis and Management of Perianal Endometriosis: Report of a Case

Cited by 19 publications

References 5 publications

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

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

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

Perianal Endometriosis Mimicking Recurrent Perianal Abscess

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