Clinical and diagnostic features of retrocervical endometriosis
Aim. To investigate clinical and diagnostic features of patients with external genital (retrocervical) endometriosis (RCE). Material and methods. The study comprised 44 patients with RCE, who were examined and underwent surgery at the V.I. Kulakov NMRC for OGP from October 2016 to December 2017. Patients were divided into four subgroups. Baseline diagnostic work-up included gynecological and somatic history and diagnostic imaging (transvaginal ultrasound (TVUS), pelvic magnetic resonance imaging (MRI), and colonoscopy). All patients underwent laparoscopic surgery. The type of surgery was chosen based on location, the depth of invasion in the affected organs, the degree of spread in the rectovaginal space, and co-occurrence of colon endometriosis. Results. The main clinical manifestations of RCE included pelvic pain, dysmenorrhea, dyspareunia, infertility, and dyschezia. The absence or presence of the endometriotic infiltration of retrocervical adipose tissue, found during the bimanual and rectovaginal examination, does not rule out infiltrating rectosigmoid endometriosis. Pelvic MRI complements ultrasound clarifying the location and extent of the endomeriotic lesion, and involvement of the pelvic organs in the pathological process. Bloating, mucus in stool, dyschezia during menstruation, ultrasound, and MRI findings suggestive of colorectal endometriosis, warrant a colonoscopy. The intraoperative findings complement and refine the data obtained during the pre-operative diagnostic work-up. Conclusion. Patients with RCE need comprehensive diagnostic evaluation with laparoscopy as the final stage, excision of endometriotic lesions, and histological confirmation of the diagnosis.Almova I.K., Khilkevich E.G., Chuprynin V.D., Tikhomirova A.A., Asaturova A.V., Chursin V.V.
Keywords
retrocervical endometriosis
pelvic pain
dysmenorrhea
ultrasound
MRI
colonoscopy
laparoscopy
References
1. Nnoaham K.E., Hummelshoj L., Webster P., d’Hooghe T., de Cicco Nardone F., de Cicco Nardone C. et al. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil. Steril. 2011; 96(2): 366-73.
2. Адамян Л.В., Андреева Е.Н. Генитальный эндометриоз: этиопатогенез, клиника, диагностика, лечение. Методическое пособие для врачей. М.; 2001. [Adamyan L.V., Andreeva E.N. Genital endometriosis: etiopathogenesis, clinic, diagnosis, treatment. A methodical manual for doctors. Moscow; 2001. (in Russian)]
3. Pagliardini L., Gentilini D., Sanchez A.M., Candiani M., Viganò P., Di Blasio A.M. Replication and meta-analysis of previous genome-wide association studies confirm vezatin as the locus with the strongest evidence for association with endometriosis. Hum. Reprod. 2015; 30(4): 987-93.
4. Holoch K.J., Lessey B.A. Endometriosis and infertility. Clin. Obstet. Gynecol. 2010; 53(2): 429-38.
5. Адамян Л.В., Яроцкая Е.Л., Чупрынин В.Д. Современный взгляд на проблему эндометриоза. Качество жизни. Медицина. Болезни органов репродуктивной системы. 2004; 3(6): 21-7. [Adamyan L.V., Yarotskaya E.L., Chuprinin V.D. Modern view on the problem of endometriosis. The quality of life. Medicine. Bolezni organov reproduktivnoy sistemy. 2004; 3(6): 21-7. (in Russian)]
6. Коган Е.А., Парамонова Н.Б., Демура Т.А., Файзуллина Н.М., Овакимян А.С., Адамян Л.В. Морфологический субстрат и патогенетические механизмы синдрома тазовой боли при эндометриозе. Архив патологии. 2014; 76(6): 37-43. [Kogan E.A., Paramonova N.B., Demura T.A., Fayzullina N.M., Ovakimyan A.S., Adamyan L.V. Morphological substrate and pathogenetic mechanisms of pelvic pain syndrome in endometriosis. Archiv patologii. 2014; 76(6): 37-43. (in Russian)]
7. Roman H., Ness J., Suciu N., Bridoux V., Gourcerol G., Leroi A.M. et al. Are digestive symptoms in women presenting with pelvic endometriosis specific to lesion localizations? A preliminary prospective study. Hum. Reprod. 2012; 27(12): 3440-9.
8. Чупрынин В.Д., Мельников М.В., Хилькевич Е.Г., Горшкова О.Н., Хачатрян А.М., Абраамян М.С., Гус А.И. Отдаленные результаты хирургического лечения глубокого инфильтративного эндометриоза. Акушерство и гинекология. 2015; 8: 78-82. [Chuprynin V.D., Melnikov M.V., Pavlovich S.V., Khilkevich E.G., Gorshkova O.N., Khachatryan A.M., Abraamyan M.S., Gus A.I. Surgical treatment for deep infiltrating endometriosis: Long-term results. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2015; (8): 78-82. (in Russian)]
9. Busard M.P., van der Houwen L.E., Bleeker M.C., Pieters van den Bos I.C., Cuesta M.A., van Kuijk C. et al. Deep infiltrating endometriosis of the bowel: MR imaging as a method to predict muscular invasion. Abdom. Imaging. 2012; 37(4): 549-57.
10. Erdem S., Imboden S., Papadia A., Lanz S., Mueller M.D., Gloor B., Worni M. Functional outcomes after rectal resection for deep infiltrating pelvic endometriosis: long-term results. Dis. Colon Rectum. 2018; 61(6): 733-42.
11. Мельников М.В., Чупрынин В.Д., Аскольская С.В., Хабас Г.Н., Матроницкий Р.Б., Вередченко А.В., Бурыкина П.Н., Попов Ю.В., Хачатрян А.М., Хилькевич Е.Г. Диагностика и тактика хирургического лечения инфильтративного эндометриоза у пациенток репродуктивного возраста. Акушерство и гинекология. 2012; 7: 42-50. [Melnikov M.V., Chuprynin V.D., Askolskaya S.V., Khabas G.N., Matronitsky R.B., Veredchenko A.V., Burykina P.N., Popov Yu.V., Khachatryan A.M., Khilkevich E.G. Infiltrative endometriosis in reproductive-aged patients: Diagnosis and surgical tactics. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2012; (7): 42-50. (in Russian)]
12. Демидов В.Н., Адамян Л.В., Хачатрян А.К. Ультразвуковая диагностика эндометриоза. I. Ретроцервикальный эндометриоз. Ультразвуковая диагностика в акушерстве, гинекологии и педиатрии. 1995; 2: 70-8.
13. Bachmann R., Bachmann C., Lange J., Krämer B., Brucker S.Y., Wallwiener D. et al. Surgical outcome of deep infiltrating colorectal endometriosis in a multidisciplinary setting. Arch. Gynecol. Obstet. 2014; 290(5): 919-24.
14. Bazot M., Bharwani N., Huchon C., Kinkel K., Cunha T.M., Guerra A. et al. European society of urogenital radiology (ESUR) guidelines: MR imaging of pelvic endometriosis. Eur. Radiol. 2017; 27(7): 2765-75.
15. Malzoni M., Di Giovanni A., Exacoustos C., Lannino G., Capece R., Perone C. et al. Feasibility and safety of laparoscopic-assisted bowel segmental resection for deep infiltrating endometriosis: a retrospective cohort study with description of technique. J. Minim. Invasive Gynecol. 2016; 23(4): 512-25.
Received 06.04.2018
Accepted 20.04.2018
About the Authors
Indira K. Almova, postgraduate student of the Surgery Department, National Medical Research Center of Obstetrics, Gynecology, and Perinatology namedafter Academician V.I. Kulakov, Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +79054357317. E-mail: www.gold11@mail.ru
Elena G. Khilkevich, MD, obstetrician-gynecologist of the Surgery Department, National Medical Research Center of Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov, Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +74954387783.
E-mail: e_khilkevich@oparina4.ru. ORCID ID: 0000-0001-8826-8439
Vladimir D. Chuprynin, PhD, Head of the Surgery Department, National Medical Research Center of Obstetrics, Gynecology, and Perinatology named
after Academician V.I. Kulakov, Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +74954383575. E-mail: v_chuprynin@oparina4.ru
Alexandra A. Tikhomirova, 7th year student of the medical faculty of Pirogov Russian National Research Medical University.
Tel.: +79265750789. E-mail: www.gold11@mail.ru
Alexandra V. Asaturova, PhD, senior scientific researcher of pathology department, National Medical Research Center of Obstetrics, Gynecology, and Perinatology named after Academician V.I. Kulakov, Ministry of Health of Russia.
117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +74954382311. E-mail: a_asaturova@oparina4.ru
Vyacheslav V. Chursin, doctor surgeon of the Surgery Department, National Medical Research Center of Obstetrics, Gynecology, and Perinatology named
after Academician V.I. Kulakov, Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +74954387833. E-mail:v_chursen@oparina4.ru
For citations: Almova I.K., Khilkevich E.G., Chuprynin V.D., Tikhomirova A.A., Asaturova A.V., Chursin V.V. Clinical and diagnostic features of retrocervical endometriosis. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2018; (6): 45-53. (in Russian)
https://dx.doi.org/10.18565/aig.2018.6.45-53
Similar Articles
