A cross-sectional descriptive study on the quality of life, anxiety and depression among Filipino patients with pelvic endometriosis

Objective@#To determine the impact of endometriosis on the quality of life, risk of anxiety and depression among Filipino women in a tertiary hospital. @*Methods@#A cross-sectional study was conducted among 210 patients aged 18-50 diagnosed clinically and sonographically with pelvic endometriosis. Verbal and written consent were secured. Descriptive statistical analysis was used to describe the baseline characteristics of the population. Short Form McGill Pain Questionnaire (SF-MPQ) was used to assess the degree of pain symptoms of the patients. WHO Quality of Life Tool (WHOQOL-BREF), Hamilton Anxiety Scale (HAM-A) and Hamilton Depression Scale (HAM-D) in Filipino version were used to evaluate the quality of life, anxiety and depression of the respondents. Series of paired t-tests were performed to determine the differences in the average outcomes (i.e. level of depression, anxiety, quality of life and subscales, pain scores and types of pain). McNemar’s chi-square test was utilized to determine the differences in the frequency of mild to severe anxiety and depression before and after treatment. Spearman’s rho rank correlation was performed to determine the relationship of the level of pain to the outcome measures. One-way analysis of variance was performed to determine differences in the current mean levels of depression, anxiety, quality of life and its subscales across disease conditions (i.e. endometriosis alone, myoma uteri, adenomyosis, other gynecologic conditions, infertility). The level of significance was set at a p-value < 0.05 using two-tailed comparison. @*Results@#The most common symptoms reported were the presence of dysmenorrhea (90.95%) and pelvic pain (88.57%), which were both rated at pain scale 8/10. Majority (73.8%) of patients have some form of depression (mild-28.57%, moderate-27.13%, severe-13.33%, very severe-4.76%) with an average level of depression at 12.39 ± 6.5. Majority (54.76%) of patients likewise have some form of anxiety (mild-15.24%, moderate-20.95%, severe-18.57%) with an average level of anxiety at 15.44 ± 10.38. Depression and anxiety scores significantly decreased after medical treatment. In terms of overall quality of life and perceived level of health, respondents demonstrated an average score of 3.25 ± 0.91 and 2.86 ± 0.96, respectively. These post-treatment scores showed significant improvement from baseline. The sub-domains (i.e. physical, psychological, social and environmental) also have relatively high scores ranging from 13.44 ± 2.39 to 15.60 ± 2.63. These are indicative of very satisfactory quality of life.Other gynecologic conditions, such as infertility, myoma uteri, and adenomyosis, do not contribute significantly to the outcomes measured.@*Conclusion@#Pelvic endometriosis is a chronic, life-long, inflammatory disease that presents mainly as pelvic pain. This debilitating pain can significantly affect patients’ psychological well-being and mental health, which is manifested by the very high incidence of anxiety and depression among Filipino women with endometriosis. Management of endometriosis is complex, hence a multi-disciplinary approach that includes psychiatric counseling may be necessary.

Endometriosis con infiltración aislada del nervio ciático, una forma de presentación atípica: reporte de un caso clínico / Isolated infiltrative endometriosis of the sciatic nerve, an atypical presentation: clinical case report

INTRODUCCIÓN: La endometriosis afecta hasta un 10-15% de las mujeres jóvenes. Se define como tejido endometrial funcional fuera de la cavidad uterina y su presentación clásica es la dismenorrea. La variedad profunda afecta a un 1-2% y las localizaciones más frecuentes son el peritoneo pélvico, ovarios, ligamentos útero-sacros y septum recto-vaginal; sin embargo, puede presentarse de forma muy infrecuente como implantes aislados localizados en relación al nervio ciático. El diagnóstico habitualmente es complejo y tardío, dado que los síntomas son inespecíficos y el examen físico puede ser indistinguible de otras etiologías. El estudio imagenológico de elección para la endometriosis profunda es la resonancia magnética (RM) de pelvis ya que una adecuada localización pre-quirúrgica de las lesiones es fundamental. CASO CLÍNICO: Paciente de sexo femenino de 46 años, con tres años de dolor pélvico, dismenorrea y dispareunia. El síntoma cardinal fue dolor ciático progresivo, con déficit motor y alteraciones sensitivas, los cuales se exacerbaban durante la menstruación y no presentaban respuesta al tratamiento farmacológico. En la RM se identifica nódulo sólido sospechoso de endometriosis en relación al nervio ciático derecho. El caso es evaluado por un comité multidisciplinario y se realiza cirugía laparoscópica. El diagnóstico de sospecha es confirmado histológicamente. La paciente presenta buena recuperación post-quirúrgica y cese completo de los síntomas descritos. DISCUSIÓN: La endometriosis profunda presenta un reto diagnóstico y habitualmente es tardío. Este caso presenta el resultado exitoso de una buena sospecha clínica, un estudio imagenológico completo y la resolución con una técnica quirúrgica compleja.

INTRODUCTION: Endometriosis is a disease that affects 10-15% of young women. It is characterized as functional endometrial tissue outside the uterine cavity. The most common form of presentation is dysmenorrhea. Deep endometriosis affects 1-2% of the patients, and is frequently located in the pelvic peritoneum, ovaries, utero-sacral ligaments and recto-vaginal septum. The isolated endometriosis of the sciatic nerve is a very uncommon presentation of this disease. Late diagnosis is frequent, mainly because the symptoms are non-specific, and the physical examination may be indistinguishable from other etiologies. The imaging study of choice is the pelvic magnetic resonance imaging (MRI) and an accurate pre-surgical location of the lesions is critical for a successful surgical outcome. CLINICAL CASE: 46-year-old female patient with 3 years of pelvic pain, dysmenorrhea and dyspareunia. The cardinal symptom was progressive sciatic pain, with motor deficit and sensory alterations. The pain was persistent despite pharmacological treatment and exacerbated during menstruation. MRI identifies a nodule located in the pelvic portion of the right sciatic nerve, suggestive of an endometriosis implant. The case was discussed by a multidisciplinary committee and laparoscopic surgery was performed. The diagnosis was confirmed with histology. The patient recovered well from surgery with significant improvement of the previously described symptoms. DISCUSSION: The diagnosis of deep endometriosis is challenging and usually delayed. This rare disease had a successful outcome, due to an early clinical suspicion, a thorough imaging study and an effective resolution with a complex surgical technique.

General surgeon’s experience in managing extra pelvic endometriosis

Two unusual cases of extrapelvic endometriosis are discussed here. Both presented themselves to the general surgeons. Case 1 presented with cyclical painful abdominal wall mass at the left iliac fossa region. Ultrasound and computed tomography scan showed a solitary mass at the subcutaneous region and fine needle aspiration cytology revealed endometriosis. The patient underwent wide surgical excision and recovered. Case 2 presented with painless swelling at the left inguinal area whilst being pregnant. Surgical exploration was performed for ‘left inguinal hernia’ but an encysted mass was found in the inguinal canal which was excised. Histopathological examination reported endometriosis. Both cases were subsequently under gynaecological follow-up. It is important for the surgeons to include endometriosis as one of the differential diagnosis in the management of their female patients with mass or swelling.

Tratamiento laparoscópico resectivo por endometriosis severa con compromiso colorrectal: factibilidad y seguridad / Laparoscopic resective treatment for severe endometriosis with colorectal involvement: feasibility and safety

Introducción: La endometriosis intestinal es una forma severa de esta entidad, afectando hasta un 12% de estas pacientes. Su tratamiento quirúrgico resulta difícil debido a la distorsión anatómica que genera, más aún cuando el abordaje es el laparoscópico. Objetivo: Analizar la factibilidad y seguridad terapéutica de las resecciones colorrectales laparoscópicas por endometriosis severa. Diseño: Observacional retrospectivo de una base de datos prospectiva. Material y métodos: Pacientes operadas con diagnóstico de endometriosis con compromiso colorrectal a las cuales se les realizó una resección intestinal entre enero de 2003 y septiembre de 2013. Resultados: De 1343 casos operados, 17 pacientes fueron intervenidas por endometriosis severa con compromiso colorrectal. Edad media 35 años (rango 23 - 47), IMC medio 22 kg/m2 (rango 18 – 35).El segmento frecuentemente afectado fue el recto (52%) y la unión rectosigmoidea (30%).En 9 pacientes se realizó una resección anterior baja, 4 de ellas requirieron ostomía derivativa; 5 pacientes recibieron una Resección anterior alta y 3 pacientes una hemicolectomía derecha. Tiempo operatorio medio 187 min (rango 60 - 360) y el sangrado operatorio medio 90cc (rango 20 - 500). Índice de conversión 11%. No se registraron complicaciones intraoperatorias. Estadía hospitalaria media 4 días (rango 2 - 10).Morbilidad global 23%.Se observaron complicaciones postoperatorias mayores en 1 caso (dehiscencia anastomótica) y menores en 3 casos (retención urinaria). No se registró readmisión hospitalaria y la mortalidad fue nula. Conclusiones: El tratamiento laparoscópico de la endometriosis intestinal severa es una opción factible y segura. En centros entrenados, puede ser adoptada como primera opción en el manejo de la endometriosis pelviana con severo compromiso colorrectal.

Background: Deep infiltrating endometriosis with bowel involvement is an aggressive form of endometriosis with an incidence up to 12%.It´s surgical management represents a challenge because of the distortion of the anatomy this entity produces, even more so when the approach is laparoscopical. The aim of this study was to evaluate the feasibility and security of colorectal laparoscopic resections for bowel endometriosis. Materials and methods: All patients presenting to the Department of Colorectal Surgery with bowel endometriosis from January 2003 to September 2013 were identified from a prospective database and retrospectively analyzed. Results: From 1343 colorectal laparoscopic procedures, 17 patients received surgery because of bowel endometriosis. Median age 35 years (range 23 to 47) and median BMI 22 kg/m2 (range 18 to 35). The most affected segments included Rectum 52% and the Rectosigmoid junction 30%. Resections included 9 low anterior resections (4 of them required fecal diversion), 5 High anterior resections and 3 Right Hemicolectomies. Median operating time was 187 minutes (range 60 to 360). Conversion rate 11%. Median length of stay was 4 days (range 2 to 10). There were none intraoperative complications. Global morbidity rate was 23%. Postoperative major complications occurred in 5.8%: one patient presented an anastomotic leak. There were 3 minor complications consistent of urinary retentions. There were no readmissions and mortality rate was nule. Conclusions: Laparoscopic surgery of bowel endometriosis is a feasible and safe therapeutic option. In trained centers, it can be adopted as the first option in the management of deep infiltrating pelvic endometriosis with bowel involvement.

Clinical analysis of reoperation on 47 cases of recurrent pelvic endometriosis / 中国综合临床

Objective To explore the effects of reoperation on treatment of recurrent pelvic endometriosis(RPEM).Methods The clinical data of 47 cases of RPEM reoperation in our hospital from April 2005 to October 2010 was investigated,and the efficacy was analyzed compared with the first operation data.Results The cases of painful nodules was significantly different between reoperation group and the first operation group(28 vs 14,x2 =8.436,P =0.004 ).There was significant difference on laparoscopic surgery cases between reoperation group and the first operation group (25 vs 40,x2 =7.259,P =0.007 ).The operation time in reoperation group was significantly longer than that in the first operation group( [ 106.4 ±41.0] min vs [ 78.4 ± 26.4 ] min,t=3.995,P ＜ 0.01 ),and the amout of intraoperative hemorrhage in reoperation group was more than that in the first operation group ( [ 143.2 ± 118.3 ] ml vs [ 70.6 ± 68.1 ] ml,t =3.660,P ＜ 0.01 ).However,there was no significant difference on symptoms,cyst location and clinical stage between these two groups(P ＞0.05).Conclusion Due to the pelvic adhesion would be dense and extensive in RPEM,it should be carefully dissected during reoperation.At the same time,the operator should pay attention to the anatomical location and try to restore the normal anatomy of the pelvic organs and physiological state,and try to reduce postoperative adhesions.Complete removal of the lesions is the key to improve the treatment effect and prevent recurrence and reoperation.

Clinical analysis of 1272 cases of pelvic endometriosis / 中国综合临床

Objective To assess the surgical effectiveness of pelvic endometriosis (EMS) by Laparoscopic. Methods Retrospective analysis was performed in 1272 pelvic EMS patients underwent laparoscopic surgical treatment. All patients were classified into four groups according to the R-AFS,63 patients of Ⅰ stage,44 patients of Ⅱ stage,475 patients of Ⅲ stage and 690 patients of Ⅳ stage. Symptoms of EMS,surgical effect and follow-up outcomes were compared. Results In all stages, there were no significant differences on moderate to severe dysmenorrhea,increase in CA125 and infertility (Ps ＞ 0. 05 ). In the EMS patients combined with AM or/and DIE, the rates of the moderate to severe dysmenorrhea, CA125 increase and infertility were 84.6% (11/13 ) ,92.3 %(12/13) and 53.8% (7/13)in stage Ⅰ ,81.8% (9/11) ,90. 9% ( 10/11 )and 54.5% (6/11) in stage Ⅱ ,84.8%(173/204) ,93. 1% (190/204) and 47.1% (96/204) in stage Ⅲ ,and 81.6% (213/261) ,91.2% (238/261) and 46.4% ( 121/261 ) in stage Ⅳ, respectively. The rates in non-consolidated AM or/and DIE patients were 46.0%(23/50),62.0% (31/50) and 22.0% ( 1 1/50) in stage Ⅰ ,45.5 % ( 15/33 ),54.5% ( 18/33 ) and 18.2% (6/33)in stage Ⅱ ,41.7% ( 113/271 ) ,62.7% ( 165/271 ) and 23.6% (64/271) in stage Ⅲ ,and 47.3% (203/429),60.1% (248/429) and 21.7% (93/429). The difference between the two groups with and without consolidated AM or/and DIE had statistical significance( P ＜ 0.05 or P ＜ 0.01 ). After the treatment, the scores of life's energy, ache,emotion,sleep,social activity and body movement of NHP were significantly superior than those before treatment in all patients ( P ＜ 0.01 ). The surgery time-consuming of Ⅲ and Ⅳ stage patients were (64.5 ± 18.4) min and (61.7 ± 17.1 ) min respectively, which were significantly higher than that of Ⅰ and Ⅱ stage ( ( 31.9 ± 12.3 ) min and (40.3 ± 10. 6) main ] ( t = 20.25, P ＜ 0.01 ). The massive hemorrhages and the internal damage organs occurred in Ⅲ and Ⅳ stage surgery [2.9% and 3.5% ,respectively] ,whereas much less in Ⅰ and Ⅱ stage (0.8% and 1.4% ) ,with no significant difference(P ＞0. 05). After treatment,the rate of symptoms recurrence of Ⅲ and Ⅳ stage patients respectively were 21.4% ,which were higher than that of Ⅰ and Ⅱ stage patients ( 2.3% ) (P ＜ 0.05 )The rate of pregnancy in Ⅲ and Ⅳ stage patients ( 15.4% ) were lower than that of Ⅰ and Ⅱ stage patients (69. 6% ) ( P ＜ 0. 01 ). Conclusions Pelvic EMS decreased the quality of life. EMS patients combined with adenomyosis or/and deep infiltrating EMS have more severe pelvic pain symptoms, less surgical effectiveness and more serious complications. Ⅲ and Ⅳ stage patients are more liable to symptoms recurrence and lower pregnancy rate.

Endometriosis and myoma concurrently arising after laparoscopic subtotal hysterectomy / 대한산부인과학회지

Iatrogenic endometriosis and leiomyoma are rare complication of laparoscopic subtotal hysterectomy. I experienced a case of pelvic endometriosis and leiomyoma concurrently arising after laparoscopic subtotal hysterectomy 2 years ago. The patient was a 43-year-old woman, and her chief complaint was palpable mass with pelvic pain in pelvis. Contrast-enhanced computed tomography image showed multiple well enhanced masses. She underwent laparoscopic surgery which revealed pelvic endometriosis and leiomyomas. The solid masses in cul-de-sac and on the surface of rectum were revealed endometriosis. The solid masses on the surface of anterior abdominal wall and descending colon were revealed leiomyoma. Implantation of viable endometrial and leiomyoma tissues could occur during uterine morcellation at time of laparoscopic subtotal hysterectomy in some patients. Vigorous irrigation and meticulous inspection should be performed.

Simultaneous Presence of Pelvic Endometriosis and Polycystic Ovary Syndrome

The simultaneous presence of polycystic ovary syndrome with pelvic endometriosis presents compounded gynecological effects on women with subfertility and pelvic pain as the common symptoms. . We describe one such case. The molecular basis for etiology is discussed and the need for individualized treatment is suggested.