Total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, excision of rectovaginal endometriosis and rectal shave

 

Patient:

➢45 yrs

➢P1 VD

➢Presented with severe pelvic pain, dysmenorrhoea, dyspareunia, and dyschezia

➢Family complete

 

Management:

➢MRI pelvis

➢Referral to colorectal

➢Multidisciplinary team meeting (MDT)

➢Commenced on GnRH analogues (Zoladex 3.6mg) monthly injections

 

MRI:

➢Diffuse adenomyosis

➢Endometriotic plaque in the region of the uterine torus

➢Posterior uterine wall tethered to the recto-sigmoid

➢The plaque measured 2.1 cm in length and 1.2 cm in depth, invading the muscularis layer of the recto-sigmoid while sparing the rectal mucosa

 

MDT:

➢MDT recommendation:

     ▪Offer pelvic clearance (TLH + BSO)

     ▪Joint procedure with colorectal

     ▪Flexible sigmoidoscopy

 

Discussion:

➢Comprehensive counselling was provided

➢MRI findings, MDT recommendations, surgical plan, and risks (including potential ileostomy/stoma) were discussed.

➢Alternative treatments, such as hormonal therapy, were offered.

➢The patient was given time and follow-up appointments to support decision-making.

 

Conclusion:

This case highlights the management of grade IV endometriosis, emphasizing the surgical techniques employed. It serves as a valuable educational resource for junior trainees pursuing a career in endometriosis surgery.