DIE. Presacral/retrorectal endometriotic nodule. Big parametrial nodule. Low bowel resection.

Complex case of deep infiltrating pelvic endometriosis.

Patient has multiple operations in other surgical center.?One of the interventions required bowel (colorectal) resection with anastomosis. During the postop period, the patient developed a complication (bowel fistula), as a result of which she required a new emergency surgery - ileostomy. A new surgical intervention was needed, ileostomy reversal.

About 3 years after this complex surgical history, the patient presented to our center for the appearance of extensive endometriosis lesions in the pelvis.?

The MRI examination performed in our center revealed:?

?- important adhesions in the pelvis

?- extensive endometriotic lesion at uterine level

?- voluminous, extensive endometriotic lesion at the level of the colo-rectal anastomosis that infiltrates the anastomosis area circumferentially, about 4 cm from the external anal oriffice

?- voluminous retrorectal endometriotic nodule, in the presacral space (50/40/55mm), which extends to the level of the deep parametrium at the level of the S3-S4-S5 sacral roots, at the level of the right paraspinous muscle. ?

We performed:?

?- total hysterectomy

?- bilateral extended parametrial excision

?- excision of the parametrial nodule infiltrating the presacral fascia with the preservation of the sacral roots

?- low colorectal resection with anastomosis (complete mobilization of the descending and transverse colon)

?- ileostomy (4 weeks)

?- excision of a big vaginal nodule

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