Operation: Post Hysterectomy Large left parametrial Endometriotic nodule with extension to ureter and Recto-Sigmoid colon, treated with parametrectomy, Ureterolysis, Segmental RS resection anastomosis
44 years old G:2 P:2 with C-sections delivery and Tubal ligation 2004 was found to have endometriosis with dense colonic posterior uterine adhesion, patient continued to have sever pelvic pain on medical treatment, 6 years later she underwent TAH,LS&O and coagulation of pelvic endometriosis, pelvic pain continued again and flank left flank pain with cyclic rectal bleeding was noted which was treated with 6 cycle of GnRH agonist but after a short while symptoms returned, MRI scan 2 month prior to referral obtained by gastroenterologist revealed:
“A mass lesion 35×30 mm in anterior wall of upper rectum 10 cm from anal verge showing peripheral enhancement after contrast injection and has resulted in narrowing of lumen. Stranding are noted from mass toward surrounding fat and vaginal vault. Left ureter is deviated toward mass and with partial obstruction resulting in left hydroureter, the appearance signal characteristics and enhancement pattern of mass is mostly suggestive of tumoral lesion rather than endometriosis, no adenopathy is identified.”
Clinical Exam: large midline scar of precious laparotomy.
Bimanual Pelvic Exam: Large 4-5 cm left parametrial, Us ligament Nodule with extension to rectum about 8cm from anal verge.