title: Recurrent Hemoperitoneum During Pregnancy in Large Deep Endometriosis Infiltrating the Parametrium.
abstract: We present the case of a young woman at 16 weeks' gestation who presented to a peripheral hospital with severe recurrent hemoperitoneum related to severe deep endometriosis infiltrating the left parametrium. She underwent 2 surgical open procedures in emergency, followed by pregnancy loss. Deep endometriosis infiltrated the rectum, the vagina, and the left parametrium, leading to stenosis of the left ureter and advanced destruction of the left kidney. Ovarian reserve was low with an antimullerian hormone level at .6 ng/mL. To improve endometriosis-related symptoms and preserve fertility, a laparoscopic conservative rectal and ureteral management was proposed with an aim to relieve symptoms, avoid further destruction of the left kidney, preserve the right splanchnic nerves and inferior hypogastric plexus, and enhance spontaneous conception. We performed a combined vaginal-laparoscopic approach that consisted of vaginal infiltration resection, adhesiolysis, rectal shaving, ureterolysis, and restoration of the permeability of the fallopian tubes. Seven months after surgery the patient spontaneously conceived and is doing well.
authors.affiliation: Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Stochino Loi
authors.affiliation: Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France.
authors.forename: Basma
authors.initials: B
authors.lastname: Darwish
authors.affiliation: Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Abo
authors.affiliation: Imaging Medical Center, Paris, France.
authors.forename: Anne-Elodie
authors.initials: AE
authors.lastname: Millischer-Bellaiche
authors.affiliation: Department of Surgical Sciences, Cagliari University Hospital, Cagliari, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Angioni
authors.affiliation: Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France; Research Group 4308 "Spermatogenesis and Gamete Quality", IHU Rouen Normandy, IFRMP23, Reproductive Biology Laboratory, Rouen University Hospital, Rouen, France. Electronic address: horace.roman@gmail.com.
authors.forename: Horace
authors.initials: H
authors.lastname: Roman
mesh_terms: D000328:Adult; D020884:Colpotomy / Q000379:methods; D004715:Endometriosis / Q000150:complications* / Q000601:surgery; D005260:Female; D006465:Hemoperitoneum / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007247:Infertility, Female / Q000517:prevention & control; D007674:Kidney Diseases / Q000209:etiology; D010535:Laparoscopy / Q000379:methods; D059351:Organ Sparing Treatments / Q000379:methods; D010537:Peritoneum; D011247:Pregnancy; D012002:Rectal Diseases / Q000209:etiology; D014517:Ureteral Obstruction / Q000209:etiology; D014623:Vaginal Diseases / Q000209:etiology
keywords: Colorectal endometriosis; Deep endometriosis; Hemoperitoneum; Pregnancy; Shaving; Ureteral endometriosis; Ureterolysis