Abstract:

Pelvic endometriosis may infiltrate somatic nerves causing severe neuropathic symptoms with a high impact on quality of life. It is a medical condition poorly known, and few published data about involvement of femoral nerve are available. We report an isolated unilateral endometriosis lesion of the left lumbar region infiltrating the femoral nerve in a 38-year-old woman. She described severe dysmenorrhea, dyspareunia, dischezia, and chronic pelvic pain with irradiation to the anterior part of the left thigh. After investigation, it was identified as a 5-centimeter endometriotic nodule involving the femoral nerve and the psoas muscle. The patient was treated by two laparoscopic surgeries with neurolysis of the involved somatic nerve by a multidisciplinary team, with improvement of the symptoms. Laparoscopic neurolysis is the first approach advocated in these cases, leading to relief of neurological symptoms resulting from nerve infiltration by endometriosis.

Authors:

Cláudia Andrade, MD, Minimally Invasive Gynecologic Surgery Fellow, Department of Obstetrics and Gynecology, Centro Hospitalar Lisboa Norte – Hospital Universitário de Santa Maria, Lisbon, Portugal, Gynecology and Obstetrics Resident, Department of Obstetrics and Gynecology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal, Sónia Barata, MD, Clinical Assistant, Minimally Invasive Surgery, Department of Obstetrics and Gynecology, Centro Hospitalar Lisboa Norte – Hospital Universitário de Santa Maria, Lisbon, Portugal, Francisco António, MD, Clinical Assistant, Department of Neurosurgery, Centro Hospitalar Lisboa Norte – Hospital Universitário de Santa Maria, Lisbon, Portugal, Conceição Alho, MD, Clinical Assistant, Department of Obstetrics and Gynecology, Centro Hospitalar Lisboa Norte – Hospital Universitário de Santa Maria, Lisbon, Portugal, Carlos Calhaz-Jorge, PhD, Professor of Gynecology , Department of Obstetrics and Gynecology, Centro Hospitalar Lisboa Norte – Hospital Universitário de Santa Maria, Lisbon, Portugal, Faculdade de Medicina de Lisboa, CAM – Centro Académico de Medicina de Lisboa, Lisbon, Portugal, Filipa Osório, MD, Clinical Assistant, Minimally Invasive Surgery, Department of Obstetrics and Gynecology, Centro Hospitalar Lisboa Norte – Hospital Universitário de Santa Maria, Lisbon, Portugal, Faculdade de Medicina de Lisboa, CAM – Centro Académico de Medicina de Lisboa, Lisbon, Portugal

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