McCormick James T, Read Thomas E, Akbari Robert P, Sklow Bradford, Papaconstantinou Harry T, Geyer Stanley, O'Keefe Lea, Caushaj Philip F
Division of Colon and Rectal Surgery, Department of Pathology, Western Pennsylvania Hospital, Clinical Campus of Temple University School of Medicine, 4800 Friendship Avenue, Pittsburgh, PA 15224, USA.
J Reprod Med. 2007 Aug;52(8):733-6.
Isolated perineal endometrioma is a rare entity and often causes diagnostic uncertainty.
Three premenopausal women, none with a prior history of endometriosis, presented with vague perineal pain 3-6 months following obstetric delivery with episiotomy. The latency periods between the onset of symptoms and definitive diagnosis were 3 months, 18 months and 3 years despite multiple physician evaluations in the interim. Patient presentation and management were virtually identical in all cases. Detailed questioning revealed that the pain was located adjacent to the episiotomy incision and waxed and waned with menses. Physical examination revealed a vague fullness adjacent to the episiotomy incision. Endoanal ultrasound revealed a mass of mixed echogenicity adjacent to the external anal sphincter. Transperineal exploration revealed a tumor with the gross appearance of an endometrioma, which was confirmed histologically. Excision of the mass with preservation of the anal sphincter muscle resulted in resolution of symptoms in all patients without the need for hormonal manipulation. No patient suffered diminution of fecal continence.
Occult perineal endometriosis should be considered when a woman presents with cyclic pain in the perineum following delivery and episiotomy. Endoanal ultrasound can assist with the diagnosis. Transperineal excision with sparing of the anal sphincter can be curative, without compromising continence.
孤立性会阴子宫内膜瘤是一种罕见的疾病，常导致诊断上的不确定性。
三名绝经前女性，均无子宫内膜异位症病史，在产科分娩并进行会阴切开术后3 - 6个月出现会阴隐痛。尽管在此期间经过多次医生评估，但症状出现至明确诊断的潜伏期分别为3个月、18个月和3年。所有病例的患者表现和治疗方式基本相同。详细询问发现疼痛位于会阴切开术切口附近，且随月经周期加重和缓解。体格检查发现会阴切开术切口附近有模糊的饱满感。经肛门超声显示肛门外括约肌附近有一个混合回声团块。经会阴探查发现一个外观上为子宫内膜瘤的肿瘤，组织学检查得以证实。保留肛门括约肌肌肉切除肿块后，所有患者症状均得到缓解，无需激素治疗。没有患者出现大便失禁情况。
当女性在分娩与会阴切开术后出现会阴部周期性疼痛时，应考虑隐匿性会阴子宫内膜异位症。经肛门超声有助于诊断。保留肛门括约肌的经会阴切除术可治愈该病，且不会影响控便功能。
