(91) Perineal endometriosis at site of post-operative vaginal stenosis in adolescent with history of urogenital reconstruction

Background: Endometriosis is defined as the presence of endometrial glands and stromal lesions outside the uterus, typically existing on peritoneal surfaces in the pelvis, with potential invasion of other organ tissue. Perineal endometriosis is a rare condition that has previously been reported in the adult patient but has not been reported in a pediatric patient. Patients with obstructive Mullerian anomalies are known to have an increased risk of endometriosis, but the risk of endometriosis in the patient with a patent but stenotic menstrual tract is unknown.

Case:

Case: The patient is a 17 yo female with congenital urogenital sinus who underwent a urethroplasty and vaginoplasty in early childhood. She subsequently developed a urethrovaginal fistula and vaginal stenosis that limited her ability for vaginal penetration but allowed for painless menstrual egress. At time of fistula repair and vaginoplasty revision, she was noted to have nodular blood-filled tissue at the site of the stenosed vagina which was completely excised. Pathology confirmed endometriosis.

Comments:

Conclusion: Perineal endometriosis should be considered in the patient with post-operative vaginal stenosis and, if suspected on examination, should be completely excised at the time of revision vaginoplasty to avoid recurrent stenosis and perineal pain.