Deep Endometriosis Affecting the Rectosigmoid and Vagina: A Surgical Strategy to Preserve Functionality

Abstract

Study Objective

The aim of this video is to demonstrate a surgical technique to remove vaginal and rectum endometriosis preserving noble structures and functionality.

Design

Video Article

Setting

Patient undergoing general and spinal anesthesia, stayed in a Trendelemburg and modified lithotomy position - buttocks placed above 5-10cm above the edge of operating table, thighs slightly abducted, legs supported by stirrups maintaining knees flexion of 90 degree. The initial 11mm incision was done in the umbilical scar, and another three abdominal 5mm incisions were made to establish a triangle position of trocars.

Patients or Participants

Female patient, 36 years old, reporting intense dysmenorrhea since menarche, that turned to acyclic pelvic pain, dyschesia and dyspareunia for the past two years, that limits her activities and sex life. Upon vaginal examination, retrocervical nodulation and a 3cm vaginal fornix nodule were identified, along with bilateral thickening of the uterosacral ligaments. In addition, a vaginal length of 8cm was measured.

In transvaginal ultrasound for endometriosis, a retrocervical nodule extending to the uterine torus, uterosacral ligaments, left paracervical region, and vaginal fornix, measuring 1.5 cm, was identified, in addition to two lesions in the rectosigmoid at 12 and 16 cm from the anal margin.

Interventions

A laparoscopy for excision of endometriosis lesions, partial colpectomy and retossigmoidectomy has been done after clinical evaluation and precise diagnosis.

Measurements and Primary Results

Immediately after surgery, patient received a progressive diet to reestablish retossigmoid function and pain medication, with complete recovery without any complications. 60 days after surgery, patient reported complete relief of pelvic pain and dyspareunia. In examination, a vaginal length of 10cm was measured.

Conclusion

This case and video emphasizes the clinical relevance of endometriosis with vaginal and rectal lesions, and highlights the surgical strategy in this type of surgery, that could remove all endometriosis lesions, preserving functionality and returning quality of life to the patient.