診断および治療に腹腔鏡下手術が有用であった卵巣外子宮内膜症性嚢胞の一例

抄録

  Endometriosis may occur in various parts of the body, but it rarely forms a cystic mass outside of the ovary. We had a case of extra-ovarian endometrial cyst that underwent laparoscopic surgery.

Case: A 38 year-old, gravida 1, para 1 woman experienced acute abdominal pain and was taken to the receiving hospital by ambulance. She was hospitalized for 6 days on diagnosis of a ruptured endometrial cyst. After discharge she was referred to our hospital. She underwent abdominal myomectomy 4 years prior and cesarean section 2 years before the current episode. Ultrasonography and magnetic resonance imaging (MRI) scan detected an endometrial cyst of 10 cm in size and normal bilateral ovaries. The origin of the mass was not clear. A slight elevation in tumor markers CA125 (77.6 U/mL) and CA19-9 (47.2 U/mL) was observed. She underwent laparoscopic surgery after one month. At laparoscopy, a fist-sized cyst was detected in the ventral portion of the uterus and chocolate-like, dark brown fluid pooled in the abdominal cavity. The cyst adhered extensively to the surrounding tissue; thus, we peeled off the adhesions and removed the cyst. The cyst was attached to the right uterosacral ligament. The uterus and both ovaries were normal and showed no anatomical connection with the cyst. The pathological diagnosis was endometrial cyst, but there was no evidence to suggest any involvement of the ovary. Her postoperative course was uneventful and she was discharged at postoperative day 3. There has been no sign of recurrence for 5 years.