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Abstract: The patient had been experiencing dysmenorrhea, anal swelling, and lower abdominal pain for half a month, and recently visited our hospital because of the aggravation of the symptoms present. The patient was finally diagnosed with deep endometriosis by giving her relevant gynecological examination and after carefully questioning the patient’s condition. After communicating with the patient and her family, we agreed to perform laparoscopic deep endo-focal resection, and the patient recovered well after the operation, and her symptoms all improved.
Basic information】Female, 26 years old
Type of disease】Deep endometriosis
Hospital】Shengjing Hospital of China Medical University
Date of consultation】September 2021
Treatment plan】Surgical treatment (laparoscopic deep endometriosis excision) + oral medication (denogestrel tablets)
Treatment period】1 week of inpatient treatment and regular outpatient follow-up
Effectiveness】The patient’s symptoms have improved and her condition has been cured.
I. Initial consultation
The patient, Ms. Zhang, complained of dysmenorrhea, anal swelling and perianal pain for about half a month, but at first she felt that it did not affect her daily life and work, and took oral pain medication to relieve some of her symptoms. Until recently, the patient’s symptoms gradually worsened and became unbearable, so she came to our hospital accompanied by her family.
The patient underwent a special gynecological examination, which showed that the uterine body had no abnormal morphology, the myometrium had uniform echogenicity, five follicular echogenicity in the left ovary and four follicular echogenicity in the right ovary, and there was no obvious liquid dark area in the pelvis. After the outpatient administration of denogestrel tablets, slight relief of symptoms was observed, and the patient was subsequently admitted to the hospital for further treatment.
II. Treatment history
The patient was clearly diagnosed with deep endometriosis, which required surgical treatment. After communication with the patient and her family, it was agreed to perform laparoscopic deep endo-focal resection for treatment. During the operation, the patient was found to have severe pelvic adhesions and dense adhesions between the intestinal canal and the pelvic mass, so the intestinal adhesions were separated and the extensive endometriosis foci in the pelvis were removed more thoroughly while protecting the ovarian function, and the operation went smoothly. After the operation, the patient and her family were instructed to take precautions, and the patient was discharged to recuperate at home after a period of recovery in the hospital and after the relevant examination, which proved that the patient’s current condition was in remission.
III. Treatment effect
On the day of surgery, the patient’s basic signs were within the normal range, and there was no fever, dizziness, headache and other symptoms, only slight abdominal pain and abdominal distension, and the patient was given to continue to observe the changes in his condition. At 1 week after the operation, the patient was able to perform some daily activities without any discomfort, and the patient’s surgical incision was healing well without signs of infection, so he was discharged home to recuperate. One month after the operation, the patient went to the outpatient clinic for a review, and the results showed that the patient’s condition had been cured.
IV. Notes
I was very pleased to see the improvement of the patient’s condition, but I still need to remind the patient to pay attention to some matters in daily life: 1.
1. Patients should avoid sexual intercourse and strenuous exercise for a short time after the treatment.
2, remind patients to pay attention to abdominal warmth, especially in autumn and winter, otherwise it may lead to aggravation of the disease. Daily hot water bags can be used to apply hot compresses, or drink more hot water, etc., can be corresponding to reduce the patient’s local discomfort.
3, daily attention to adjust personal emotions, avoid frequent anger, not only is not conducive to their own health, may also lead to endocrine abnormalities. Patients are advised to increase physical activity, which can increase their immunity on the one hand, and prevent recurrent attacks on the other.
V. Personal insight
Clinical diagnosis of deep endometriosis is usually defined as lesion infiltration depth ≥0.5 cm and involvement of a wide range of sites. The main manifestations of most patients are similar to those of the patient in this case, all of whom have dysmenorrhea, lower abdominal pain, anal swelling, perianal pain, and other symptoms include pain in the lower limbs, chronic pelvic pain, and painful intercourse.
In addition, surgery is currently the primary option for the treatment of deep endometriosis, but the patient’s own anatomical location makes it difficult to perform the surgery, so it is necessary to communicate clearly with the patient and her family before performing the surgery to avoid leading to misunderstandings.