Wenger J M, Soave I, Lo Monte G, Petignat P, Marci R
Department of Gynecology and Obstetrics, Division of Gynecology, Geneva University Hospitals, Geneva, Switzerland.
J Pediatr Adolesc Gynecol. 2013 Feb;26(1):e1-4. doi: 10.1016/j.jpag.2012.06.005. Epub 2012 Nov 15.
Endometriotic lesions affect the fallopian tubes in 6% of patients with endometriosis and adhesions involve the salpinges in 26%. Different studies report that 45%-70% of adolescents with chronic pelvic pain have endometriosis diagnosed at the time of laparoscopy.
We report a case of an 18-year-old girl with a tubal torsion due to a tubal endometrioma. The endometriotic nodule before laparoscopy appeared to be located in the rectovaginal septum. At laparoscopy, a right fallopian tube torsion was visible and several adhesions were connecting the lesion to the pouch of Douglas' walls.
The tenacious adhesions, which welded the nodule to the walls of the pouch of Douglas, did not allow to distinguish at the MRI a tubal endometrioma from a rectovaginal endometriotic mass, justifying the false diagnosis.
子宫内膜异位症患者中，6%的患者异位病灶累及输卵管，26%的患者输卵管存在粘连。不同研究报告称，45%-70%的慢性盆腔疼痛青少年在腹腔镜检查时被诊断为患有子宫内膜异位症。
我们报告一例18岁女孩，因输卵管子宫内膜瘤导致输卵管扭转。腹腔镜检查前，子宫内膜异位结节似乎位于直肠阴道隔。腹腔镜检查时，可见右侧输卵管扭转，有多处粘连将病灶与Douglas陷凹壁相连。
将结节与Douglas陷凹壁粘连在一起的坚韧粘连，使得在磁共振成像（MRI）上无法区分输卵管子宫内膜瘤和直肠阴道子宫内膜异位肿块，从而导致了误诊。
