Endometriosis Case Report | Symptoms, Diagnosis & Treatment

A case report on Endometriosis

R. Nivetha¹, C. Malathi², R. Ruby³

¹Staff Nurse, Kauvery Hospital, Maa Kauvery, Trichy, Tamil Nadu

²Nursing Supervisor, Kauvery Hospital, Maa Kauvery, Trichy, Tamil Nadu

³DNS, Kauvery Hospital, Maa Kauvery, Trichy, Tamil Nadu

Abstract

A Right Salpingo – Oophorectomy and Left Ovarian Cystectomy are two different gynecologic surgical procedures often performed together when there are issues affecting both ovaries and fallopian tubes. Its involves the surgical removal of the right ovary and fallopian tube. Left ovarian cystectomy involves the surgical removal of a cyst from the left ovary, leaving the rest of ovary intact.

Case Presentation

A 27 Years old female presented with complaints of abdomen pain on & off for the past 1 year. She was on medical management since 2023. Now came for further management.

On Examination

Patient conscious, oriented, afebrile

No pallor/No pedal edema

PR :78/min

BP :100/70 mmHg

CVS: S1S2(+)

RS: NVBS (+)

P/A: Soft

P/V: Cervix pointing downwards, Uterus AV Right forniceal fullness (+)

Menstrual history

Regular cycle 3-4 / 30 days

Marital history: Married since 10 years / NCM

Obstetric history: P1 L1 / Previous LSCS / Female / 8 years / Alive & healthy Not sterilized

Past history: Laparoscopic right ovarian cystectomy in March 2023

Patient Present Complaints

Abdomen pain on & off past 1 year.

Recurrent endometric cyst

H/O Dysmenorrhea

Investigation

Investigation	Patient value	Normal value
HB	13.8g/dl	12-15 mg/dl
Platelet count	232000cells/cum	140000-400000 cell/cum
NA+	140mmol/l	136- 145mmol/l
K+	4.25mmol/l	305-5mmol/l
Urea	26mg/dl	10-36mg/dl
Creatinine	0.66mg\dl	136 – 145 mg/dl
INR	0.99	0.8-1.2
Total Bilurubin	0.48mg/dl	0.2-1.3mg/dl
SGOT	23u/l	14-38u/l
SGPT	18u/l	9-52u/l
TSH	2,014m\u\l	0.270-5.350m/u/l
RBS	94/mg/dl	70-140mg\dl
Blood Group	O Positive

Ultrasonogram Abdomen and Pelvis

Pelvis study showed right ovary shows large well defined anechoic cyst of size 8.3 – 5.6CM with homogenous ground glass echogenicity within it and with multiple thin septation – endometric cyst . Right Large Endometriotic Ovarian Cyst.

CA 125: 25.0

AMH on 01.03.2025: 2.65 ng/mL

Echo Cardiogram: Normal study

Diagnosis: Large Right Ovarian Cyst (Endometriosis).

Treatment Given

Drug name	Strength	Route of admin	Frequency
Inj..Taximax	1.5gm	IV	1-O-1
Inj.Tramadol	50gm	IV	SOS
Inj.Emeset	4mg	IV	1-0-1
Inj.Pantop	40mg	IV	1-0-1
Tab.Taximax O	200mg	PO	1-0-1
Tab.Calpol	500mg	PO	1-1-1
Tab.Pan	40mg	PO	1-0-1

Surgery Notes: Right salpingo oophorectomy + Left ovarian cystectomy done on 06.03.2025, underGA.

Intra op findings: Right ovarian cyst of size 9×7 cm endometriotic cyst noted, found adherent to posterior surface of uterus, same released

Right salpingo oophorectomy done
Left ovarian cyst of size 3×2 cm noted
Left ovarian cystectomy done, Specimen retrieved via endobag and sent for HPE
Hemostasis secured.
Ports closure done with staples
Clear urine drained.

Post-Operative Medical Management

Patient received in post-operative ward and vitals monitored regularly.
Managed with iv fluids and antibiotics.
Periodical pain assessment done and analgesics administerd according to pain score.
Early ambulation encouraged
Post-operative period was uneventful.
Patient shifted to ward. General condition good.
Followed all HIC bundle care

Nutritional Follow Up

Provided High protien diet and high fibre diet.

Cancer Surveillance

Cyst wall Fragments-Histological features suggestive of endometriosis cyst.
Fallopian Tube-Histological features suggestive of organizing pyosalphinx.

Emotional and psychological support

Provided emotional support and counseling to the patient and their family members. It helped them to cope up with the change to their body image and life style.

S. No	Drug name	Strength	Frequency	Route
1.	Tab. Taxim o	200mg	Bd	Oral
2.	Tab. Pan	40mg	Bd	Oral
3.	Tab. Calpol	500mg	Tds	Oral
4.	Tab. Shelcal HD12	1	Od	Oral

Condition at Discharge

General condition good

Vitals stable

Advised the patient to report immediately to emergency department in case of Giddiness, breathlessness, bleeding PV, abdominal pain, discharge of pus from wound site.

Advised for review in Gynecology OPD with HPE report.

Book picture

Definition

Endometriosis is the chronic medical condition in which tissue similar to the lining of the uterus (endometrium) grows outside the uterus.

This misplaced tissue behaves like normal uterine lining-thickens, breaking down, and bleeding with each menstrual cycle. This leads to inflammation, pain and sometimes formation of scar tissue (adhesion).

Causes

Retrograde menstruation

Genetic factors

Immune system disorders

Hormonal imbalances

Symptoms

Severe menstrual cramps(dysmenorrheal)

Pelvic Pain, pain during bowel movements, heavy menstrual bleeding or spotting between periods

Infertility, fatigue, Diarrhea, constipation, bloating, nausea

Common Sites Affected

Ovaries
Fallopian tubes
Outer surface of the uterus
Pelvic lining
In severe cases: intestines, bladder or event distant organs

Diagnostic Methods

Pelvic exam
Ultrasound or MRI
Laprascopy

Treatment options

Medical management

Analgesics
Hormonal therapies

Surgical Management

Laparoscopic removal of endometrial tissue
Hysterectomy in severe, unresponsive cases

Supportive Management

Diet and exercise
Stress management
Counseling

A case report on Endometriosis

A case report on Endometriosis

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