Polypoid Endometriosis Mimicking Peritoneal Carcinomatosis

Area of Science:

• Gynecologic Surgery
• Minimally Invasive Procedures
• Endometriosis Management

Background:

• A 36-year-old female presented with pelvic pain and bulk symptoms due to a fibroid uterus.
• History of multiple myomectomies and severe endometriosis with adhesions complicated prior surgery.
• Prolonged GnRH antagonist therapy for suspected endometriosis.

Purpose of the Study:

• To describe a case of extensive peritoneal endometriosis mimicking carcinomatosis.
• To highlight the importance of perioperative planning and multidisciplinary approach in managing complex gynecologic conditions.
• To emphasize the role of excisional techniques in endometriosis treatment.

Main Methods:

• Diagnostic laparoscopy, excision of peritoneal lesions, and total laparoscopic hysterectomy with bilateral salpingectomy.
• Intraoperative consultation with Gynecologic Oncology and frozen section biopsy.
• Excision of visible polypoid endometriotic lesions using monopolar scissors and electrosurgical desiccation.

Main Results:

• Diffuse peritoneal nodules mimicking carcinomatosis were found intraoperatively.
• Frozen section confirmed benign tissue consistent with endometriosis.
• Final pathology revealed polypoid endometriosis; no malignancy was detected.
• Patient reported significant pain improvement postoperatively.

Conclusions:

• Extensive endometriosis can present as peritoneal carcinomatosis, necessitating thorough diagnostic evaluation.
• Perioperative planning, including advanced imaging, surgeon expertise, biopsy, and multidisciplinary involvement, is crucial.
• Minimally invasive hysterectomy with excisional techniques provided effective treatment and symptom relief.