Self-inflicted chronic laparoscopic wounds in endometriosis-unveiling major depressive disorder: a case report

To our knowledge, there are no reported cases in literature of adolescents with endometriosis with major depressive disorder that manifested as chronic laparoscopic wounds. Major depressive disorder in patients with endometriosis is a common occurrence, but self-directed violence is rare. We present the case of an adolescent female with chronic pelvic pain who was treated with medical management that proved ineffective. She then underwent laparoscopic excision of endometriosis. After surgery, she continued to experience oozing of a brown colored discharge from the primary umbilical port site, and it became a chronic nonhealing wound with associated pelvic pain. Four months later, she underwent re-exploration of the umbilical wound and laparoscopy. Subsequently, she had multiple and frequent hospital visits including ward admissions. The laparoscopic wounds remained as flesh wounds for 11 months despite multidisciplinary treatment, including care from a plastic surgeon. Patient was seen by a psychiatrist and a diagnosis of major depressive disorder was made. She was started on antidepressants, and subsequently, the wounds healed. This case report discussed a young adolescent female who underwent surgical treatment for endometriosis but who presented with a cryptic manifestation of major depressive disorder- chronic postlaparoscopic wounds. This case illustrates the need for early recognition of nonreproductive complications of endometriosis and timely multidisciplinary involvement.