Severe Iliopsoas Muscle Endometriosis Managed by a Multidisciplinary Team
Harley Bray1, Nicole Delaloye1, Iain D C Kirkpatrick1
1Department of Obstetrics, Gynecology and Reproductive Sciences, the Department of Diagnostic Radiology, the Department of Pathology, and the Division of General Surgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
Background:
There is limited published guidance on management of iliopsoas muscle endometriosis, especially when muscle is extensively infiltrated.
Case:
A 38-year-old patient presented with left leg neuropathy, atrophy, edema, and catamenial bruising. Magnetic resonance imaging identified a poorly defined multiseptated cystic mass in the iliacus and inferior psoas muscle consistent with an endometrioma. After failed medical management, a multidisciplinary team was assembled for operative intervention. Excision was incomplete because the mass replaced most of the psoas muscle and obscured the femoral nerve. Postoperatively, pathology confirmed endometriosis and symptoms improved.
Conclusion:
In cases of iliopsoas endometriosis, surgical judgment should balance the dogmatic goal of complete excision with the ethical principle of nonmaleficence. Drainage and partial excision may allow for preserved muscle function and avoidance of catastrophic neurovascular injury.
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