title: The clinical features and management of perineal endometriosis with anal sphincter involvement: a clinical analysis of 31 cases.
abstract: BACKGROUND
  The aim of this study was to investigate the appropriate measures for diagnosing and treating perineal endometriosis (PEM) with anal sphincter involvement.
  
  
  METHODS
  Between January 1992 and April 2011, the clinical features, diagnosis and management of 31 patients who were diagnosed with PEM with anal sphincter involvement at the Peking Union Medical College Hospital were retrospectively analyzed using their clinical records. A range of 6-78 months of outpatient follow-up after surgery were conducted for these 31 patients but was extended by telephone interviews with 29 patients conducted in December 2011.
  
  
  RESULTS
  All 31 patients had a history of vaginal delivery. The level of serum CA(125) was elevated in only 2 (6.5%) cases. All cases received surgical treatment, which included narrow excision (NE, close to the edge of the endometrioma) with primary sphincteroplasty (PSp) for 30 cases and incomplete excision (IE) for 1 case. Of the 30 cases in the NE group, 20 (66.7%) received hormone therapy preoperatively. Up until December 2011, there was one recurrence (3.6%) of PEM in the NE group. PEM relapse occurred in the IE patient 6 years after the initial IE surgery. Perineal abscesses were found in one patient post-operatively. No complaint of dyspareunia and no fecal incontinence episodes were observed during follow-up.
  
  
  CONCLUSIONS
  Based on our own experience, NE and PSp may be indicated for the treatment of PEM with anal sphincter involvement.
authors.affiliation: Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, People's Republic of China.
authors.forename: Na
authors.initials: N
authors.lastname: Chen
authors.forename: Lan
authors.initials: L
authors.lastname: Zhu
authors.forename: Jinghe
authors.initials: J
authors.lastname: Lang
authors.forename: Zhufeng
authors.initials: Z
authors.lastname: Liu
authors.forename: Dawei
authors.initials: D
authors.lastname: Sun
authors.forename: Jinhua
authors.initials: J
authors.lastname: Leng
authors.forename: Qingbo
authors.initials: Q
authors.lastname: Fan
authors.forename: Hui
authors.initials: H
authors.lastname: Zhang
authors.forename: Quancai
authors.initials: Q
authors.lastname: Cui
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D018394:CA-125 Antigen / Q000097:blood; D004715:Endometriosis / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D010502:Perineum / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011247:Pregnancy; D012008:Recurrence; D012189:Retrospective Studies
chemical_list: D018394:CA-125 Antigen