Correlation of endoscopic findings with suspected intestinal endometriosis in the distal sigmoid and rectum as observed on transrectal ultrasonography

Introduction: Colonoscopy enables detailed endoscopic evaluation of the interior of the colon. Changes observed via colonoscopy may be subtle or pronounced and can sometimes mimic those of other diseases, such as deep intestinal endometriosis. The diagnosis of endometriosis in the distal sigmoid and rectum by colonoscopy has been described in previous case reports. Objective: We aimed to correlate the endoscopic changes found in the distal sigmoid and rectum with the presence of endometrial deposits confirmed by transrectal ultrasound (TRUS). Methods: We included 50 female patients referred to the endoscopy department at our institution for colonoscopy, rectosigmoidoscopy, or TRUS, who exhibited one or more symptoms associated with endometriosis. Results: The colonoscopic findings were normal in 36 patients but showed alterations in 14 patients. Among the latter, TRUS revealed involvement of the sigmoid and/or rectal wall in 11 patients. Conclusions: The endoscopic changes in the distal sigmoid or rectum described in this study were strongly associated with endometrial deposits confirmed using TRUS. (AU)

CA 125 elevado en contexto de endometrioma: reporte de caso / Elevated CA 125 in the context of endometrioma: case report

Introducción: Los tumores benignos de ovario corresponden a un 60-95% de las lesiones anexiales, en edad fértil los más frecuentes corresponden a quistes foliculares y endometriomas. Sin embargo, alrededor del 15% son patología maligna de ovario. Por lo que se debe evaluar aspectos como edad, características ecográficas y la presencia de marcadores tumorales específicos como CA 125. Objetivo general: Describir un reporte de caso y caracterizar la evidencia disponible sobre el abordaje de tumores benignos de ovario. Caso Clínico: Se presenta el caso clínico de una paciente en edad fértil de 43 años, cursando con dolor abdominal asociado a masa anexial, donde destaca la elevación del marcador CA 125 en rango de malignidad, por lo que se solicita valoración por oncología y manejo quirúrgico, confirmándose una masa anexial benigna de características quísticas, sugerente de endometrioma, al descartar patología maligna se realiza quistectomía total. Discusión: La patología anexial es una entidad clínica que puede abarcar características tumorales, ya sean benignas como malignas, por ello frente a lesiones ováricas, siempre se deben descartar estas últimas. Las características ecográficas de la paciente hacían sospechar de un endometrioma, el CA 125 elevado en ella hizo que se optara por un manejo quirúrgico oncológico con biopsia rápida para descartar o confirmar malignidad. Conclusión: Ante la presencia de endometriomas, el tratamiento debe discutirse caso a caso, teniendo en cuenta la sintomatología, deseos de fertilidad futura y tamaño de las lesiones.

Introduction: Benign ovarian tumors correspond to 60-95% of adnexal lesions, in childbearing years the most frequent correspond to follicular cysts and endometriomas. However, about 15% are malignant ovarian pathology. Therefore, aspects such as age, ultrasound characteristics and the presence of specific tumor markers such as CA 125 must be evaluated. General objective: Describe a case report and characterize the available evidence on benign ovarian tumors. Case report: A case of a 43 year old female of childbearing age, presents abdominal pain associated with an adnexal mass, where CA 125 elevations are found in the range of malignancy, for which an oncology evaluation and surgical management. A benign adnexal mass with cystic characteristics is confirmed, suggestive of endometrioma, when malignant pathology is ruled out, a total cystectomy is performed. Discussion: Adnexal pathology is a clinical entity that can include tumor characteristicas, whether benign or malignant, therefore, in the face of ovarian lesions, these should always be ruled out. The sonographic characteristics of the patient made one suspect an endometrioma, the elevated CA 125 in it led to an oncological surgical management with rapid biopsy to rule out or confirm malignancy. Conclusions: In the presence of endometriomas, treatmentshould be discussed individually, taking into account the symptoms, wishes for future fertility, and size of the lesions. Keywords: Ca-125 antigen, Endometriosis, Ovarian neoplasms

Exclusión renal por endometriosis profunda ureteral: a propósito de un caso / Renal exclusion due to deep infiltrating ureteral endometriosis: a case report

INTRODUCCIÓN: La endometriosis ureteral es una afección rara que afecta al 0.01-1,7% de las mujeres con endometriosis. Hasta un 30% cursa de forma asintomática y un 11,5-14,7% pueden evolucionar con falla renal. La falta de diagnóstico de la enfermedad puede terminar en una uropatía obstructiva y falla renal irreversible. Se presenta el caso de una paciente con afectación grave de la función renal secundaria a endometriosis profunda con compromiso ureteral. CASO CLÍNICO: Mujer de 35 años con endometriosis que consultó por exacerbación de los síntomas. En su estudio destaca, en la resonancia magnética, el hallazgo de endometriosis pélvica profunda y compromiso endometriósico intrínseco del uréter distal derecho, provocando una acentuada hidroureteronefrosis. El cintigrama renal demuestra acentuado compromiso de la función renal derecha, con una función relativa del 7%. Se realizaron nefrectomía total derecha y resección de enfermedad pélvica profunda laparoscópica, sin incidentes. CONCLUSIONES: La endometriosis ureteral representa un desafío diagnóstico y terapéutico. El manejo multidisciplinario entre radiólogos, ginecólogos y urólogos, mediante el diseño de una estrategia quirúrgica individualizada, es imprescindible para definir el tratamiento óptimo de estas pacientes.

INTRODUCTION: Ureteral endometriosis is a rare entity that affects 0.01-1,7% of women with endometriosis. Up to 30% of the patients are asymptomatic and 11.5-14.7% will develop renal failure. Misdiagnosis can lead to obstructive uropathy and permanent renal failure. We present the case of a patient with severe compromise of renal function secondary to deep infiltrating endometriosis with ureteral involvement. CASE REPORT: A 35-year-old woman with endometriosis presented with exacerbation of symptoms. Magnetic resonance showed deep pelvic endometriosis and intrinsic endometriotic involvement of the right distal ureter, causing a marked hydroureteronephrosis. Renal scintigram showed a severe compromise of the right renal function, with a relative function of 7%. Through laparoscopy a total right nephrectomy and resection of deep infiltrating endometriosis was performed. The patient had a satisfactory recovery in the postoperative period. CONCLUSIONS: Ureteral endometriosis presents a diagnostic and therapeutical challenge. Joint multidisciplinary management between radiologists, gynecologists and urologists through the design of an individualized surgical strategy is essential to define the optimal treatment for these patients.

Resonancia magnética en el estudio de dos pacientes con dolor pélvico crónico asociado a endometriosis de infiltración profunda / Magnetic resonance imaging in the study of two patients with chronic pelvic pain associated to infiltrating endometriosis deep

INTRODUCCIÓN: La endometriosis de infiltración profunda (EIP) es una enfermedad crónica de difícil diagnóstico, que frecuentemente es confundida con otras patologías pelvianas. OBJETIVO: Presentar dos casos de endometriosis de infiltración profunda, donde la resonancia magnética (RM) de pelvis, fue importante para el diagnóstico y planificación del tratamiento quirúrgico. CASO CLÍNICO: Se describe el caso de dos pacientes. La primera de 24 años afectada por un nódulo de EIP retrocervical con extensión intestinal sintomática y la segunda, una paciente de 37 años con una recidiva sintomática de EIP en la cúpula vaginal después de una histerectomía total. RESULTADOS: La RM de pelvis describe en ambos casos la extensión de las lesiones endometriósicas y presenta una excelente correlación con los hallazgos intra operatorios en la laparoscopía quirúrgica. CONCLUSIONES: La RM de pelvis es un excelente recurso en el estudio diagnóstico de las pacientes con dolor pélvico crónico, tanto en el caso de EIP retrocervical con extensión intestinal y también en la recidiva de EIP en la cúpula vaginal después de una histerectomía total

INTRODUCTION: Deep infiltration endometriosis (DIE) is a chronic disease of difficult diagnosis, which is frequently confused with other pelvic pathologies. OBJETIVE: To present two cases of deep infiltrating endometriosis, where the pelvic magnetic resonance imaging (MRI) was important in the diagnosis and surgical treatment planning. CLINICAL CASES: Two cases, one 24 years-old patient suffering from retrocervical DIE nodule with symptomatic bowel involvement, and a 37 years-old patient, with a symptomatic DIE at the vaginal cuff after total hysterectomy. RESULTS: Pelvic MRI describes in both cases the extension of the endometriotic lesions and presents an excellent correlation with the intra operatory findings during surgical laparoscopy. CONCLUSIONS: Pelvic MRI is an excellent diagnostic tool for patients with pelvic pain, in case of retrocervical DIE with bowel involvement, and also in recurrence of DIE at the vaginal cuff after total hysterectomy

Evaluación de fuerza de concordancia de hallazgos de endometriosis en RM y laparoscopía: análisis de una serie de casos / Assessment concordance of endometriosis findings on MRI and laparoscopy: analysis of a series of cases

OBJETIVO: Evaluar concordancia de sitios de hallazgos de endometriosis profunda encontrados por RM y laparoscopia. MATERIALES Y MÉTODOS: Estudio retrospectivo, no experimental, concordancia intertécnica. Se recolectaron datos en nuestra institución de todos los informes de RM de pelvis que incluyeran la palabra "endometriosis", entre mayo de 2015 y abril de 2018 (36 meses), identificando 339 registros. Se establecieron criterios de inclusión. De los 339 registros, 62 pacientes fueron excluidas por cirugía antes de la RM. Otras 243 pacientes fueron excluidas porque no presentaban registro de protocolo quirúrgico posterior a la RM. 34 pacientes cumplieron los criterios de inclusión del estudio, lo que equivale al 10% de las RM estudiadas. Se revisaron las ubicaciones de los implantes endometriósicos informados en RM y se correlacionaron con los hallazgos encontrados en la cirugía. Se confecciono tabla para identificar la presencia/ausencia de implantes en las ubicaciones descritas en la literatura. Análisis estadístico mediante software Stata, aplicando kappa ponderada con intervalo de confianza de 95%. RESULTADOS: El promedio de edad de las pacientes llevadas a cirugía fue de 38 años. Los lugares con correlación moderada-importante (0.41-0.80) correspondieron a útero, recto-sigmoides, ovario, vagina y fondos de saco. CONCLUSIÓN: La RM de Pelvis es fundamental en la evaluación de pacientes con endometriosis en las que se plantea un manejo quirúrgico, con el objetivo de caracterizar la ubicación, forma y número de lesiones, y así lograr un satisfactorio tratamiento laparoscópico.

OBJECTIVE: To assess inter-observer reliability of sites of deep endometriosis findings found by MRI and laparoscopy. MATERIALS AND METHODS: Retrospective, non-experimental study, inter-observer reliability. Data were collected at our institution from all pelvic MRI reports that included the word "endometriosis", between May 2015 and April 2018 (36 months), identifying 339 records. The following were established as inclusion criteria. Of the 339 records, 62 patients were excluded for surgery prior to MRI. Another 243 patients were excluded because they had no record of the surgical protocol after the MRI. 34 patients met the study inclusion criteria, equivalent to 10% of the MRIs studied. The locations of the endometrial implants reported on MRI were reviewed and correlated with the findings found in the surgery. A table was prepared to identify the presence / absence of implants in the locations described in the literature. Statistical analysis using Stata software, applying weighted kappa with a 95% confidence interval. RESULTS: The average age of the patients undergoing surgery was 38 years. The places with a moderate-important correlation (0.41-0.80) corresponded to the uterus, recto-sigmoid, ovary, vagina, and recto-uterine pouch. CONCLUSION: Pelvic MRI is essential in the evaluation of patients with endometriosis in whom surgical management is proposed, in order to characterize the location, shape and number of lesions, and thus achieve satisfactory laparoscopic treatment.

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.

Endometriose: aspectos clínicos do diagnóstico ao tratamento / Endometriosis: clinical aspects from diagnosis to treatment

A suspeita clínica de endometriose geralmente envolve a história clínica da paciente e exame físico, abordando sua sintomatologia e história pessoal e familiar. Entretanto, a apresentação clínica da doença varia consideravelmente, sem características clínicas patognomônicas, fato que dificulta o seu diagnóstico. Um diagnóstico presuntivo de endometriose pode ser fortemente sugerido pela ultrassonografia transvaginal e pela ressonância magnética em casos de endometrioma ou endometriose infiltrativa profunda. No entanto, esses exames de imagem não possuem a sensibilidade e a especificidade necessárias quando se trata de endometriose peritoneal superficial. O biomarcador sérico mais utilizado na investigação da endometriose foi o CA-125, que não apresenta sensibilidade (70%-75%) suficiente para sua indicação na prática clínica. Portanto, apesar de seu risco e alto custo, a videolaparoscopia e a análise anatomopatológica subsequente ainda se apresentam como o procedimento padrão-ouro para o diagnóstico definitivo de endometriose. Assim, com o objetivo de demonstrar quais exames seriam necessários para o diagnóstico dessa doença, realizamos uma revisão sistemática da literatura, cujos dados estão descritos a seguir.(AU)

Endometriosis ileal. Causa infrecuente de obstrucción intestinal en mujeres en edad fértil / Ileal endometriosis. An uncommon cause of bowel obstruction in women in fertile age

Resumen La endometriosis se define como la presencia de tejido endometrial fuera de la cavidad uterina. Ocurre en aproximadamente 5 a 10% de las mujeres en edad fértil. Cuando afecta al intestino tiende a confundirse clínicamente con una gran variedad de afecciones por lo cual en algunas oportunidades se le ha llamado también "la gran simuladora". La revisión de la literatura muestra que la localización intestinal es poco frecuente y que la obstrucción secundaria a esta causa es aún más inusual, siendo el diagnóstico preoperatorio un desafío para los cirujanos. Con el propósito de resaltar características clínicas y de estudio por imágenes que ayuden a la sospecha preoperatoria de esta entidad tan infrecuente en la práctica habitual, se presentan dos casos de mujeres operadas de urgencia, sin diagnóstico previo de endometriosis y con oclusión intestinal como primera manifestación de la enfermedad. El tratamiento consiste en la resección intestinal del sector afectado y anastomosis primaria. El diagnóstico se basa en un alto índice de sospecha y debería ser considerado en mujeres en edad fértil, sin antecedentes patológicos y con historia de menstruaciones dolorosas.

Abstract Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity. It affects ~5-10% of women in their reproductive years. When it affects the intestine, it tends to be confused clinically with a wide variety of affections, which is why it has sometimes been called "the great simulator". A review of the literature shows that intestinal localization is rare and that obstruction secondary to this cause is even more unusual, with preoperative diagnosis being a challenge for surgeons. With the purpose of highlighting clinical and diagnostic imaging characteristics that help the preoperative suspicion of this entity, so rare in routine practice, we present two cases of women who underwent emergency surgery, without a previous diagnosis of endometriosis and with intestinal occlusion as the first manifestation of the disease. Treatment of intestinal occlusion by endometriosis consists of intestinal resection of the affected sector and primary anastomosis. Diagnosis of intestinal occlusion secondary to ileal endometriosis is based on a high index of suspicion and should be considered in women of childbearing age, without a history of disease and with a history of painful menstruation.

Endometriose umbilical: relato de caso e revisão de literatura / Umbilical endometriosis: a case report and literature review

A endometriose é caracterizada pela presença de tecido endometrial fora da cavidade uterina. Seu mecanismo fisiopatológico é pouco esclarecido, mas várias hipóteses são descritas - dentre elas a disseminação de células endometriais por via hematogênica ou linfática. A apresentação clínica é bastante variável, mas podem estar presentes massa palpável, sangramentos cíclicos ou alterações de coloração da pele na região afetada. O diagnóstico é estabelecido a partir do exame clínico, associado a exames de imagem e biópsia da lesão. O tratamento de escolha é o cirúrgico com excisão da lesão e reconstrução da anatomia local. Apresentamos um relato de caso de uma paciente de 35 anos, com endometriose umbilical, com necessidade de excisão da lesão e confecção de novo umbigo. A evolução da afecção descrita é estritamente relacionada ao manejo diagnóstico e propedêutico instituído; sendo assim, a exclusão de diagnósticos diferenciais, benignos ou malignos, é de suma importância.

Endometriosis is characterized by the presence of endometrial tissue outside the uterine cavity. The pathophysiology of this condition is poorly understood. However, several hypotheses have been proposed, including the spread of endometrial cells via hematogenous or lymphatic routes. The clinical presentation is variable but includes a palpable nodule, cyclic bleeding, and changes in the color of the skin in the affected region. Diagnosis is established by clinical examination combined with imaging and lesion biopsy. The treatment of choice is surgical, with excision of the lesion and tissue reconstruction. We report the case of a 35-year-old female patient with umbilical endometriosis and the need for removal of the lesion with umbilical reconstruction. The presentation of this condition determines the diagnostic and management approach. Therefore, the exclusion of other benign or malignant disorders is essential.

Ultrasonographic findings in primary umbilical endometriosis

Abstract: Primary cutaneous endometriosis is a rare condition. It appears without a prior history of surgical procedure and the umbilicus is the most frequently involved area. Primary umbilical endometriosis, or Villar's nodule, usually presents as a painful nodule. Its differential diagnosis may be challenging. Although histopathological assessment represents the gold standard for diagnosis, cutaneous ultrasonography may be useful in guiding the surgical treatment. Ultrasonographic features of cutaneous endometriosis have not yet been fully explored in the literature. Hence, we report peculiar ultrasonographic findings of primary umbilical endometriosis

Cystoscopy-assisted laparoscopy for bladder endometriosis: modified light-to-light technique for bladder preservation

ABSTRACT Introduction Endometriosis is a disease with causes still unclear, affecting approximately 15% of women of reproductive age, and in 1%-2% of whom it may involve the urinary tract. The bladder is the organ most frequently affected by endometriosis, observed around 85% of the cases. In such cases, the most effective treatment is partial cystectomy, especially via videolaparoscopy. Study Objective, Design, Size and Duration In order to identify and delimit the extent of the intravesical endometriosis lesion, to determine the resection limits, as well as to perform an optimal reconstruction of the organ aiming for its maximum preservation, we performed a cystoscopy simultaneously with the surgery, employing a modified light-to-light technique in 25 consecutive patients, from September 2006 to May 2012. Setting Study performed at Campinas Medical Center – Campinas – Sao Paulo – Brazil.Participants/materials, setting and methods: Patients aged 27 to 47 (average age: 33.4 years) with deep endometriosis with total bladder involvement were selected for the study. The technique used was conventional laparoscopy with a transvaginal uterine manipulator and simultaneous cystoscopy (the light-to-light technique). A partial videolaparoscopic cystectomy was performed with cystoscopy-assisted vesical reconstruction throughout the entire surgical time. The lesions had an average size of 2.75cm (ranging from 1.5 to 5.5cm). The average surgical time was 137.7 minutes, ranging from 110 to 180 minutes. Main Results Postoperative follow-up time was 32.4 months (12-78 months), with clinical evaluation and a control cystoscopy performed every six months. No relapse was observed during the follow-up period. Conclusions A cystoscopy-assisted partial laparoscopic cystectomy with a modified light-to-light technique is a method that provides adequate identification of the lesion limits, intra or extravesically. It also allows a safe reconstruction of the organ aiming for its maximum preservation.

Endometriosis diafragmática: a propósito de un caso / Diaphragmatic endometriosis: about a case

ANTECEDENTES: La endometriosis afecta entre 5 al 15% de las mujeres en edad reproductiva. La presentación torácica es una entidad de baja frecuencia (menos del 1% de todos los casos de endometriosis), y puede localizarse en vía aérea, parénquima, pleuras o diafragma. Sus manifestaciones clínicas habitualmente se presentan dentro de las primeras 72 horas del inicio de la menstruación y consisten en dolor torácico, neumotórax o hemoptisis. El mejor manejo consiste en supresión hormonal y manejo quirúrgico en casos refractarios. OBJETIVOS: Describir un caso de endometriosis diafragmática tratada satisfactoriamente por videotoracoscopia. CASO CLÍNICO: Mujer de 27 años, con antecedentes de endometriosis ovárica operada con electrofulguración dos años previo. Consulta por omalgia derecha y dado antecedentes de endometriosis pélvica, se solicita TAC torácico, que informa formación sólida, ovoídea, de 30 mm x 13 mm, que capta contraste en forma parcial ubicado en la región subdifragmática derecha. Se interpreta imagen como posible foco de endometriosis, se complementa con RNM que es concordante con el diagnóstico. Se realiza videotoracoscopia derecha con resección diafragmática y reparación primaria. Anatomía patológica informa focos de endometriosis con márgenes negativos. Se retira la pleurostomía a las 48 horas, siendo dada de alta a los tres días. A un año de seguimiento, está asintomatica y sin evidencia de recidiva. CONCLUSIÓN: A pesar de su baja frecuencia, la endometriosis torácica representa un importante compromiso de la calidad de vida. Casos con complicaciones torácicas, con regular o deficiente respuesta a terapia hormonal, se benefician de resolución quirúrgica por vía mínimamente invasiva.

BACKGROUND: Endometriosis affects between 5 to 15% of women of reproductive age. Thoracic presentation entity is infrequent (less than 1% of all cases of endometriosis) and may be located in airway parenchyma, pleura or diaphragm. Its clinical manifestations usually occur within the first 72 hours of onset of menstruation and include chest pain, pneumothorax or hemoptysis. Better management consists of hormonal suppression and surgical management in refractory cases. OBJECTIVE: To describe a case of diaphragmatic endometriosis, successfully treated by video-assisted thoracoscopic surgery (VATS). CASE REPORT: Woman of 27 years old, with a history of ovarian endometriosis operated by electrofulguration two years before. She present right omalgia and a history of pelvic endometriosis. Chest CT report a solid, ovoid formation, 30 mm x 13 mm, which captures contrast partially, located in the right sub diaphragmatic region. Image is interpreted as a possible focus of endometriosis, it is complemented by RNM that is consistent with the diagnosis. It is performed VATS right with diaphragmatic resection and primary repair. Pathology reports endometriosis with negative margins. The pleurostomy is removed after 48 hours, she was discharged after three days. A one year follow up, it is asymptomatic and without evidence of recurrence. CONCLUSION: Despite its low frequency, the thoracic endometriosis represents an important commitment to the quality of life. Cases with chest complications, and with fair or poor response to hormone therapy, benefit with minimally invasive surgical resolution.

Correlation of the three-dimensional ultrasound findings with pathology in patients with deep pelvic infiltrating endometriosis submitted to surgery / Correlação dos achados da ultrassonografia tridimensional com o anatomopatológico em pacientes com endometriose pélvica infiltrativa profunda submetidos a tratamento cirúrgico

Objective: This study aims to correlate the findings of the three-dimensional anorectal ultrasonography (3D-AUS) with pathological findings in patients with deep pelvic infiltrating endometriosis. Methods: Prospective study of a series of 40 patients with deep pelvic infiltrating endometriosis diagnosed by three-dimensional anorectal ultrasonography and who were submitted to a laparoscopy. The specimens were examined histologically and compared with the results of the three-dimensional anorectal ultrasonography. The research was conducted between March 2008 and March 2011. Results: The results of the examinations were: 72.5% of patients (n = 29) with endometriosis, 12.5% (n = 5) with nonspecific chronic inflammatory reaction, 5% (n = 2) with nonspecific fibrous tissue, 2.5% (n = 1) with adenomyoma, 2.5% (n = 1) with colonic mucosa with foci of recent hemorrhage, edema of lamina propria and superficial erosions, 2.5% (n = 1) with hyperplasia of lymphoid follicles, and the remaining 2.5% (n = 1) with peritoneal tissue within normal limits. Conclusion: We conclude that the use of three-dimensional anorectal ultrasonography in patients with deep pelvic infiltrating endometriosis aid in the diagnosis of rectal lesions, when compared with the pathological findings of surgical specimens.

Objetivo: Este estudo visa correlacionar os achados da ultrassonografia tridimensional com os achados anatomopatológicos em pacientes com endometriose pélvica infiltrativa profunda submetidos a tratamento cirúrgico. Métodos Estudo prospectivo de uma série de 40 pacientes com endometriose pélvica: infiltrativa profunda diagnosticados pela USR-3D e submetidos à videolaparoscopia. As peças cirúrgicas foram analisadas histologicamente e comparadas com os resultados das USR-3D. A pesquisa foi desenvolvida entre março de 2008 a março de 2011. Resultados: Os resultados dos estudos histopatológicos foram: 72,5% das pacientes (n = 29) com endometriose, 12,5% (n = 5) com reação inflamatória crônica inespecífica, 5% (n = 2) com tecido fibroso inespecífico, 2,5% (n = 1) com adenomioma, 2,5% (n = 1) com mucosa colônica com presença de focos de hemorragia recente, edema de lâmina própria e erosões superficiais, 2,5% (n = 1) com hiperplasia de folículos linfoides e o restante, 2,5% (n = 1), com tecido peritoneal dentro dos limites da normalidade. Conclusão: Conclui-se, portanto que a ultrassonografia anorretal tridimensional em pacientes portadoras de endometriose pélvica infiltrativa profunda ajuda no diagnóstico de lesões retais, quando essa técnica é comparada com os achados anatomopatológicos das peças cirúrgicas.

Compromiso del tubo digestivo por endometriosis: una manifestación importante de recordar / Gastrointestinal tract affected by endometriosis: a clinical condition important to take into account

Background: Endometriosis is caused by the presence of endometrial tissue outside the uterus, affecting predominantly women in reproductive age; it is an important cause of infertility. The presence of these lesions in the digestive tract in an unusual complication, of unspecific symptoms, rarely suspected and thus its diagnosis may be delayed. The suspicion can be confirmed by means of ultrasonography or computed tomography (CT), however magnetic resonance imaging (MRI) has become the study of choice for the diagnosis and follow-up of these patients. Objective:The aim of the current review is to identify the characteristics of endometriosis and illustrate the utility and limitations of the CT and the MR in the diagnosis of this disease.

Antecedentes: La endometriosis es causada por la presencia de tejido endometrial fuera del útero que afecta predominantemente a mujeres en edad fértil y es causa importante de infertilidad. La presencia de estas lesiones en el tubo digestivo es una complicación infrecuente, de sintomatología inespecífica, escasamente sospechada y cuyo diagnóstico puede verse pospuesto. Si bien su sospecha puede realizarse mediante la ecotomografía y la tomografía computada (TC), la resonancia magnética (RM) se ha convertido en el estudio de elección tanto para el diagnóstico como el seguimiento. Objetivo: La presente revisión busca identificar las características de la endometriosis e ilustrar sobre la utilidad y limitaciones de la TC y la RM en el diagnóstico de esta enfermedad.