Perineal scar endometriosis involving the anal sphincter. A case report and review of the literature

Abstract

BACKGROUND: Perineal endometriosis is the presence of endometrial tissue in the perineal region. Early diagnosis and treatment is important due to anal sphincter involvement in almost half of the patients. Endoanal ultrasonography is a reliable technique in the assessment of perineal endometriosis with anal sphincter involvement. This report describes the presentation, clinical investigation, and surgical treatment of a perineal endometriosis case CASE REPORT: 32-year-old female patient presented with cyclic pain and swelling of an old episiotomy scar. Three-dimensional endoanal ultrasonography showed a lesion with involvement of the external anal sphincter muscles, and it was completely excised and primary sphincteroplasty was performed for the external anal sphincter defect.The final pathology result was reported as endometriosis. Postoperative periods were uneventful and anal incontinence was not observed.

CONCLUSION: Perineal endometriosis is a rare disease and may involve the anal sphincter muscles. Incomplete excision to protect the sphincters is associated with high recurrence, while extensive excision can cause anal sphincter damage that may cause anal incontinence. Endoanal ultrasonography may be necessary in surgical planning. Primary sphincteroplasty with excision may be necessary in cases of perineal endometriosis with external anal sphincter muscle involvement.