8747 Excision of Endometriosis in a Postmenopausal Patient

Abstract

<h3>Study Objective</h3> We seek to demonstrate endometriosis excision in a postmenopausal patient status post hysterectomy and explore the important clinical features of postmenopausal endometriosis. <h3>Design</h3> Case study. <h3>Setting</h3> Urban academic tertiary care center. <h3>Patients or Participants</h3> One postmenopausal female with history of biopsy proven endometriosis experiencing persistent pelvic pain and deep dyspareunia following prior total laparoscopic hysterectomy and endometriosis excision procedures. <h3>Interventions</h3> Exam under anesthesia, bilateral salpingo-oophorectomy, lysis of adhesions, excision of endometriosis, partial peritonectomy, and cystoscopy. <h3>Measurements and Main Results</h3> Intra-op findings included abundant filmy adhesions and focal hemorrhagic lesions, which appeared consistent with endometriosis. Pathology showed fibrous serosal adhesions and associated hemosiderin laden macrophages compatible with clinical impression of endometriosis, though classical findings of endometrial glands and stroma were absent. The patient reported near complete resolution of her prior symptoms following the surgery, without use of narcotic medication, and overall satisfaction with the procedure. <h3>Conclusion</h3> Endometriosis is an estrogen-mediated chronic inflammatory condition that is benign but has a significant impact on the quality of life of many people. Though symptoms are typically seen in premenopausal individuals, cases of postmenopausal endometriosis have also been shown and are estimated to account for roughly 1-5% of all cases. It is hypothesized that extra-ovarian estrogen production from adipose tissue or endometriosis implants may contribute to or drive these processes, but the precise mechanism and etiology is not well understood. Surgical management is particularly important for postmenopausal patients, especially those with endometriomas, given the increased association with malignancy. Here we present a case of a patient with postmenopausal endometriosis status post TLH who experienced significant symptom improvement following surgical treatment with bilateral salpingo-oophorectomy, partial peritonectomy, lysis of adhesions and excision of endometriosis lesions. More research is needed to fully understand the etiology, impact, and appropriate treatment options for postmenopausal endometriosis.