Lady delivers a baby through C-section while undergoing surgery for endometriosis

Undergoing a complicated surgery which involved delivering a baby through C-Section and simultaneous removal of widespread endometriosis, a 32-year-old Indian found relief from years of excruciating and chronic pain. The Bahraini resident had been suffering from severe endometriosis pelvic pain and had tried multiple treatments to alleviate the condition but all had failed. Despite attending several hospitals she was unable to get right treatment of her condition. With such a highly complex gynaecological problem, she finally met Dr Yasmin Kazi, Advanced Laparoscopic Gynaecologist, Obstetrician and Fertility Consultant at Bahrain Specialist Hospital.

Detailed examination with imaging at the hospital revealed a large area of endometriosis in the patient’s belly wall, and Dr Kazi suggested the patient undergo surgery for removing the endometriosis area. However, since this surgery would have endangered her chances of recurrence and because she was planning for another baby, the treatment was put on hold until the next delivery. Soon after she conceived and C-section with the removal of the abnormal area was planned at the time of delivery. The patient had already undergone two C-sections in earlier pregnancies with a dense scar that made the final surgery more complex and difficult to undertake. She also had a large protuberant belly.

Endometriosis occurs when tissue similar to the lining of the uterus grows outside it, often on the ovaries, bowel and tissues lining the pelvis. During menstrual cycle this tissue thickens, breaks and bleeds like an endometrial tissue; but unlike the latter, it gets trapped since it cannot leave the body via menstruation. This irritates the surrounding tissues and eventually leads to scarring and adhesions of pelvic tissues.

“It was a challenging surgery on several levels,” explained Dr Kazi, who’s well trained in dealing complex Gynecologic problems and related surgeries. “To begin with, by the time the patient had conceived and was ready to deliver, the endometriosis mass on her belly wall had grown to a significant proportion. Secondly, we had to surgically treat the endometriosis while delivering the baby with the protuberant belly and previous surgical scars made the surgery extremely difficult.”

“Additionally, during surgery, we found non-absorbable suture material in her belly wall that was used during previous surgeries. Sutures are the rows of stitches used to hold together an incision and when non-absorbable material is used in the procedure, it aggravates the problem and the entire area gets encased in the endometriosis tissue, encouraging the condition to spread, in this case in her belly wall. In addition, due to recurrent internal bleeding these areas changed to dense scars making fresh surgical access to her belly extremely difficult,” added Dr Kazi.

Despite many challenges, the surgery was successful and the big mass of endometriosis was removed relieving the patient from chronic pain. There was a large defect in the rectus sheath, the layer that covers the belly wall. In order to prevent recurring endometriosis, the doctor repaired this large defect in an innovative way with absorbing sutures, without the use of mesh material — a widely used material used to repair the weakened pelvic tissue. But since it can by itself provoke endometriosis scar formation in its vicinity, it was avoided in this case.

The main symptoms of endometriosis are unbearable pain during periods. Heavy bleeding, bleeding at unusual times and infertility is also experienced in many cases. A thorough evaluation by an experienced gynaecologist with appropriate imaging remains the mainstay to identify the condition. Although there is no cure for the condition, in modern medicine, symptoms can be largely abated by medications. Surgery is often required in cases where medical management fails or if endometriosis is encountered in unusual locations like the belly wall, as was in this case.