Nour Abdoulrazak Egueh, Abdillahi Chirwa Mahamoud, Bennani Samia, Bouh Ahmed Hared, Nawal Bouknani, Rami Amal
Department of Radiology, Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health (UM6SS), Casablanca, Morocco.
Department of Pediatrics, Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health (UM6SS), Casablanca, Morocco.
Pan Afr Med J. 2025 May 28;51:25. doi: 10.11604/pamj.2025.51.25.48002. eCollection 2025.
Endometriosis is a chronic, non-cancerous gynecological disorder that is typically observed in women of fertile age. It describes the presence of functional endometrial components, glands and stroma outside the endometrial cavity, most often involving pelvic structures such as the ovaries, peritoneum, and uterine ligaments. Perineal endometriosis is a rare form of extrapelvic endometriosis, with an estimated incidence of between 0.3% and 1%. We report the case of a 36-year-old woman, gravida 1 para 1(G1P1), with a history of vaginal delivery and no known history of endometriosis, who presented with a painful mass located on the right perineal scar two years after undergoing a mediolateral episiotomy. The mass was associated with cyclical pain and significantly impaired quality of life. Clinical examination, combined with ultrasound and Magnetic Resonance Imaging (MRI), suggested the diagnosis of perineal endometriosis in the absence of other endometriotic lesions. As the patient declined surgery, hormonal therapy was initiated, resulting in marked symptom improvement at 8-month follow-up. Although histological confirmation was not obtained, the typical clinical presentation, evocative MRI features, and favorable response to hormonal therapy supported the diagnosis of perineal endometriosis. This under-recognized entity should be systematically considered in women of reproductive age presenting with cyclical perineal pain following episiotomy.
子宫内膜异位症是一种慢性非癌性妇科疾病,通常在育龄女性中出现。它指的是子宫内膜腔外存在功能性子宫内膜成分、腺体和间质,最常见于盆腔结构,如卵巢、腹膜和子宫韧带。会阴子宫内膜异位症是盆腔外子宫内膜异位症的一种罕见形式,估计发病率在0.3%至1%之间。我们报告一例36岁经产妇(孕1产1,G1P1),有阴道分娩史,既往无子宫内膜异位症病史,在进行会阴侧切术后两年,右侧会阴瘢痕处出现疼痛性肿块。该肿块伴有周期性疼痛,严重影响生活质量。临床检查结合超声和磁共振成像(MRI),在无其他子宫内膜异位病变的情况下提示会阴子宫内膜异位症的诊断。由于患者拒绝手术,开始进行激素治疗,在8个月的随访中症状明显改善。虽然未获得组织学确诊,但典型的临床表现、MRI特征以及对激素治疗的良好反应支持会阴子宫内膜异位症的诊断。对于有会阴侧切术后周期性会阴疼痛的育龄女性,应系统考虑这种未被充分认识的疾病。