Apresentação clínica e abordagem terapêutica da endometriose em musculatura reto abdominal: um relato de caso

Abstract

Endometriosis is a benign condition that affects approximately 70 million women worldwide. It is one of the most important causes of pelvic pain and infertility. The recto abdominal muscles are a rare site of implantation of endometriosis lesions. After thorough research, few cases of similar presentation were found in the literature around the world. This is the first case of endometriosis in the rectus abdominis muscles to be described in the state of Sergipe. Within this context, a 35-year-old patient, diagnosed with adenomyosis, with a history of 1 cesarean section and 2 surgeries to excise previous endometriosis lesions, sought gynecological care due to chronic pelvic pain and progressive pain in a cesarean section scar refractory to the use of hormonal therapy. An MRI revealed signs of new foci of endometriosis in the abdominal wall. As a result, a new surgical approach was chosen, however, this time not only with the excision of the endometriotic lesion, but also with the removal of the uterus (also compromised by Adenomyosis) and its annexes, including the ovaries. As a postoperative complication, there were repeated formations of serous collection in the abdominal wall that required successive drainage, however, without compromising the patient's general condition, which improved with all preoperative complaints. Additionally, hormone replacement therapy was prescribed to control climacteric symptoms resulting from the removal of the ovaries, with a global and substantial improvement in quality of life. In view of this report, it is important to highlight that radical surgery should always be considered as a reproducible model in cases of similar evolution, aiming to avoid recurrences and surgical re-approaches.