This video presentation follows a case of a patient with a large myoma and stage IV endometriosis requiring bowel resection.

Design:

Case presentation and surgical video outlining the steps taken during the surgery.

Setting:

Sydney, Australia

Patients or Participants:

41-year-old was referred into our service with a large fibroid and severe endometriosis.

She had severe dysmenorrhea and severe diarrhoea during her menses, up to 12 times/day with associated dyschezia and abdominal cramping.

The mass was found incidentally during a massage which prompted an ultrasound. Other than lower abdominal pressure she has no urinary symptoms or pressure symptoms.

She is G0P0, attempted to fall pregnant in her 30’s and sought fertility opinion but didn’t pursue this. She did however prefer to preserve fertility if possible

Interventions:

An MRI abdomen/pelvis was performed and showed a large anterior pedunculated fibroid from the fundus measuring 173x170x86mm.

At the posterior margin of the uterus and cervix there is a large 28x27x21mm dense infiltrating plaque of endometriosis. This involves the posterior lower half of the uterine body, the uterocervical junction and lower cervix. Drawn into this is an elongated segment of the sigmoid colon and the right ovary which is involved by a large endometrioma 84x76x73mm within the pouch of douglas.

The length of the sigmoid involvement is estimated to be at least 55mm.

She was counselled multiple times and saw a colorectal colleague who discussed options including high possibility of a need for a bowel resection and the associated risks involved.

She was booked and consented for a laparoscopic myomectomy with in-bag morcellation, laparoscopic excision of severe endometriosis +/- bowel surgery.

Measurements and Main Results:

She had an uncomplicated joint procedure between gynaecology and colorectal surgeon.

Conclusion: