Skip to main content Accessibility help
Hostname: page-component-5d59c44645-klj7v Total loading time: 0 Render date: 2024-02-29T06:50:28.581Z Has data issue: false hasContentIssue false

Case 58 - A 28-Year-Old G0 Woman with Stage IV Endometriosis and an Obliterated Posterior Cul-de-sac

Published online by Cambridge University Press:  19 November 2021

Todd R. Jenkins
University of Alabama, Birmingham
Lisa Keder
Ohio State University School of Medicine, Columbus
Abimola Famuyide
Mayo Clinic, Rochester
Kimberly S. Gecsi
Medical College of Wisconsin
David Chelmow
Virginia Commonwealth University School of Medicine
Get access


A 28-year-old nulligravid woman presents reporting severe dysmenorrhea, deep dyspareunia, and dyschezia that worsens with menses. She states she has always had painful periods, but they have worsened over the past year. She describes it as sharp, twisting, and feels that something is “stabbing her from the inside out.” She is in a long-term relationship and desires future fertility. She has tried several different combined oral contraceptive pills, which mildly improved her pain. She has also tried non-steroidal anti-inflammatory drugs, medroxyprogesterone acetate, and a gonadotropin-releasing hormone agonist without relief. She states the dyspareunia and constipation have worsened over time. She underwent a diagnostic laparoscopy at age 26 and was told she had stage IV endometriosis. She continues to have debilitating pain that significantly impacts her quality of life. She would like to proceed with fertility-sparing surgical management. She has no other relevant relevant past medical or surgical history. She is currently taking oral contraceptives (ethinyl estradiol/norethindrone) and has no known drug allergies.

Surgical Gynecology
A Case-Based Approach
, pp. 177 - 179
Publisher: Cambridge University Press
Print publication year: 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Balasch, J, Creus, M, Fábregues, F, et al. Visible and non-visible endometriosis at laparoscopy in fertile and infertile women and in patients with chronic pelvic pain: a prospective study. Hum Reprod 1996; 11: 387–91.CrossRefGoogle ScholarPubMed
Carter, JE. Combined hysteroscopic and laparoscopic findings in patients with chronic pelvic pain. J Am Assoc Gynecol Laparosc 1994; 2: 43–7.CrossRefGoogle ScholarPubMed
Nisenblat, V, Bossuyt, PMM, Farquhar, C, Johnson, N, Hull, ML. Imaging modalities for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev 2016; 2(2): CD009591. doi: 10.1002/14651858.CD009591.Google ScholarPubMed
Abrão, MS, Petraglia, F, Falcone, T, et al. Deep endometriosis infiltrating the recto-sigmoid: critical factors to consider before management. Hum Reprod Update 2015; 21: 329–39.CrossRefGoogle ScholarPubMed
Bazot, M, Bornier, C, Duberbnard, G, et al. Accuracy of magnetic resonance imaging and rectal endoscopic sonography for the prediction of location of deep pelvic endometriosis. Hum Reprod 2007; 22: 1457–63.CrossRefGoogle ScholarPubMed
Soto, E, Luu, TH, Liu, X, et al. Laparoscopy vs. robotic surgery for endometriosis (LAROSE): a multicenter, randomized, controlled trial. Fertil Steril 2017; 107: 9961002.e3.CrossRefGoogle Scholar
Pundir, J, Omanwa, K, Kovoor, E, et al. Laparoscopic excision versus ablation for endometriosis-associated pain: an updated systematic review and meta-analysis. J Minim Invasive Gynecol 2017; 24: 747–56.CrossRefGoogle ScholarPubMed
Hart, RJ, Hickey, M, Maouris, P, Buckett, W. Excisional surgery versus ablative surgery for ovarian endometriomata. Cochrane Database Syst Rev 2008; (2): CD004992. doi: 10.1002/14651858.CD004992.pub3.Google ScholarPubMed
Wu, Z, van de Haar, RC, Sparreboom, CL, et al. Is the intraoperative air leak test effective in the prevention of colorectal anastomotic leakage? A systematic review and meta-analysis. Int J Colorectal Dis 2016; 31: 1409–17.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the or variations. ‘’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats