Sacral Nerve Infiltrative Endometriosis Presenting as Perimenstrual Right-sided Sciatica and Bladder Atonia: Case Report and Description of Surgical Technique

Sacral Nerve Infiltrative Endometriosis Presenting as Perimenstrual Right-sided Sciatica and Bladder Atonia: Case Report and Description of Surgical Technique

Author Lemos, Nucelio Autor UNIFESP Google Scholar
Kamergorodsky, Gil Autor UNIFESP Google Scholar
Ploger, Christine Autor UNIFESP Google Scholar
Castro, Rodrigo Autor UNIFESP Google Scholar
Schor, Eduardo Autor UNIFESP Google Scholar
Girao, Manoel Autor UNIFESP Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Abstract Endometriosis infiltrating the sacral nerve roots is a rarely reported manifestation of the disease. the objectives of this article are to report such a case and to describe the surgical technique for laparoscopic decompression of sacral nerve roots and treatment of endometriosis at this site. the patient as a 38-year-old woman who had undergone 2 previous laparoscopic procedures for electrocoagulation of peritoneal endometriosis and self-reported perimenstrual right-sided sciatica and urinary retention. Clinical examination revealed allodynia (pain from a stimulus that does not normally cause pain) on the S2 to S4 dermatomes and hypoesthesia on part of the S3 dermatome. Magnetic resonance imaging showed an endometriotic nodule infiltrating the anterior rectal wall. Laparoscopic exploration of the sacral nerve roots demonstrated vascular compression of the lumbosacral trunk and endometriosis entrapping the S2 to S4 sacral nerve roots, with an endometrioma inside S3. the endometriosis was removed from the sacral nerve roots and detached from the sacral bone, and a nodulectomy of the anterior rectal wall was performed. Normal urinary function was restored on postoperative day 2, and pain resolved after a period of post-decompression. Intrapelvic causes of entrapment of sacral nerve roots are rarely described in the current literature, either because of misdiagnosis or actual rareness of the condition. Recognition of the clinical markers for these lesions may lead to an increase in diagnosis and specific treatment. Journal of Minimally Invasive Gynecology (2012) 19, 396-400 (C) 2012 AAGL. All rights reserved.
Keywords Bladder dysfunction
Buttock pain
Endometriosis
Sacral nerves
Sciatic nerve
Sciatica
Language English
Date 2012-05-01
Published in Journal of Minimally Invasive Gynecology. New York: Elsevier B.V., v. 19, n. 3, p. 396-400, 2012.
ISSN 1553-4650 (Sherpa/Romeo, impact factor)
Publisher Elsevier B.V.
Extent 396-400
Origin http://dx.doi.org/10.1016/j.jmig.2012.02.001
Access rights Closed access
Type Article
Web of Science ID WOS:000304026800025
URI http://repositorio.unifesp.br/handle/11600/34855

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