A 35-Year-Old American Woman Diagnosed and Successfully Treated for A Dangerous Type of Bowel Endometriosis at ACI Cumballa Hill Hospital
Amid pandemic, reproductive health problems are on rising. A team headed by Dr Abhishek Mangeshikar, a consultant laparoscopic and robotic gynaecologist, ACI Cumballa Hill Hospital, successfully diagnosed and treated a 35-year-old American woman with a large endometriosis nodule in the mid and upper rectum almost resulting in occlusion, and inability to conceive due to significant endometriosis and adenomyosis. The patient who complained of chronic period pain, constipation, and bloating resumed her daily routine now and is also scheduled to undergo an IVF treatment soon in the US.
Mrs MB from Boston MA has endured symptoms of severe pelvic pain, constipation, and bloating that hampered her daily activities for most of her adult life. Even after taking medication and trying home remedies, her pain continued to worsen. When she was in India, she came to incidentally see Dr Abhishek Mangeshikar, to schedule an appointment for a hysteroscopy prior to an IVF scheduled in the US, who helped her get rid of the pain and suffering at ACI Cumballa Hill Hospital, Mumbai at the end of July 2021.
Dr Abhishek Mangeshikar, consultant laparoscopic and robotic gynaecologist, ACI Cumballa Hill Hospital, said, “The patient had a history of severely painful periods as well as severe constipation and bloating. Her ultrasound examination revealed a large endometriosis nodule in the mid and upper rectum almost resulting in occlusion. These findings were further corroborated by MRI.
Bowel endometriosis can be seen when tissues similar to the uterine lining grow on the bowel or intestine. It is the most common type of extra pelvic endometriosis. About 12 % of cases affect the rectum and sigmoid colon. In India, an estimated 25 million patients suffer from endometriosis. Extrapolating that 12% would mean 3 million Indian people assigned female at birth suffers from bowel endometriosis. We have treated 80 patients over the last year with advanced endometriosis and almost 60% had bowel involvement.
In this particular case delaying treatment could cause intestinal obstruction which could become a life-threatening complication because the patient would be unable to pass stools and the intestine would eventually perforate leading to severe complications such as sepsis and possibly death.
The surgery is not only useful at improving quality of life and reducing pain but also improves fertility. In a publication by Roman et al, 80 % of patients treated for bowel endometriosis had successful pregnancy outcomes in the first year or two after surgery. Out of that 80%, 2/3rds conceived naturally!
“Since she was scheduled to return to the US soon, I reached out to her US doctors with her findings and they couldn’t take on the case due to its complexity. After reaching out to multiple doctors in the US, she received the same answers and finally decided to extend her stay in India. She underwent surgery on 20th July 2021. An exploratory laparoscopy for excision of endometriosis with segmental resection anastomoses of the rectum was carried out to treat a frozen pelvis with excision of endometriosis and resection of the rectum which showed involvement of about 10cms of length. The procedure lasted for 7 hours, and the patient underwent surgery with minimal blood loss and was discharged on post-op Day 7 without even a week after her surgery. She is already back in the US and will undergo her IVF procedures as scheduled. “It is important that these diagnoses are not missed. There is a need to dramatically improve the diagnostics and standard of care for these patients,” said Dr Abhishek Mangeshikar.
“My symptoms were constipation, painful periods, and bloating that was enough for me to make me want to cut out my uterus with a knife. My periods would haunt me like the first 2 days of my menses were petrifying. I would change my pad from time to time and still find myself with a sordid bloody pool on the bed, and the pain gave me nightmares. I felt as if my pain threshold is low, and suffered in silence. My family was supportive and helped me with hot water bottles, painkillers, and even sympathy that I will be fine. But no one had really heard of endometriosis, also it was the last thing on my mind. I was physically, mentally, and emotionally disturbed. I was just looking out for ways to end my suffering. I thank Dr Abhishek for his limitless efforts to help me get back on track. Now, I will undergo an IVF treatment, and fulfil my dream of embracing motherhood. I feel relieved now. Do not ignore this condition, seek timely treatment,” concluded patient Mrs MB
