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Archive for the ‘Endometriosis’ Category

Academic OB/GYN Cases – Large Abdominal Wall Endometrioma with Mesh Reconstruction

Case:

 

41 year old woman with a history of an abdominal myomectomy followed by a pregnancy, ending in cesarean delivery.  Over time a firm mass could be felt in the abdominal wall which was swollen with her menses.  She had been seen by several physicians who were unable to clearly diagnose the mass.  She eventually was diagnosed by a new PCP, and was referred to our office for treatment.

On being seen in our office, we ordered and reviewed MRI images, which demonstrated abdominal wall endometriosis replacing a large segment of the left rectus abdominus muscle and overlying fascia.

 

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These images demonstrated the mass to be approximately 4 x 3 cm in size, with marked gadolinium enhancement in several areas.

A plan was made to do a laparotomy, with expectation that after removal there would be a significant defect in the fascia, likely requiring mesh repair.

Read more…

Surgical Video: Robotic Endo Resection with Superficial Rectal Resection

 

Dr Nicholas Fogelson of Pearl Women’s Center in Portland, OR demonstrates resection of severe bilateral pelvic endometriosis with superficially invasive anterior rectal wall disease.

Dr Fogelson is available for clinical consultation through Pearl Women’s Center in Portland, OR. 503-771-1883.

email: info@pearlwomenscenter.com
email: drfogelson@gmail.com

On Hysterectomies and Oophorectomies for Endometriosis

September 25, 2016 Leave a comment

As many of you know, I spend a fair amount of time involved in social media outlets, particularly with efforts to support and educate women struggling with endometriosis.   Women with this condition are fortunate to have access to a variety of very active and vigorous advocacy and education groups, and in these groups there is a lot of great information.  At the same time, I occasionally note in these groups that there can be some dogmatic views, and at times I think that there is some incomplete information being passed around.  Perhaps the biggest area I see this in when the topic of hysterectomy for endometriosis is discussed.

Typically the exchange goes like this:

“I have been struggling with endometriosis for X years and have Y symptoms, and my doctor has recommended a hysterectomy.”

Very quickly (within minutes) there will be the response

“Hysterectomy does not treat endometriosis”

or even
“HYSTERECTOMY DOES NOT TREAT ENDOMETRIOSIS!!”

This always rubs me the wrong way.   This is not because it is wrong, but because it is incomplete.  Read more…

Surgical Video -Ovarian Suspension for Endometriosis Resection

Dr Nicholas Fogelson of Pearl Women’s Center in Portland, OR demonstrates a technique for temporary ovarian suspension. This technique is useful for lifting the ovaries off the pelvic sidewall, exposing the area for treatment of endometriosis or other pathology.

 

On the Funding of Endometriosis Surgery

January 23, 2016 5 comments

As many of my readers know, I spend a fair amount of time online. I love interacting with other docs that do what I do, and even more so, I love interacting with women that have the conditions that I treat. Even though I have left academics, I am a teacher at heart, and enjoy the opportunity to pass on what I have learned when I can.

One of the biggest questions I see is about how endometriosis care is paid for.Cash-Loan

Unlike typical care, many endometriosis physicians are not under contract with insurers for care. This creates a whole different system for payment of medical care that is confusing to many patients – so let me explain it here. Read more…

On Lena Dunham, and Why it is Hard to Find a Skilled Endometriosis Physician

January 4, 2016 6 comments

Recently I read an article by Lena Dunham, describing her life with endometriosis, treatment she has undergone, and how her life has been since.  Its a very poignant article about a successful woman who has been held back by her condition, yet also a story of incredible perseverance despite tremendous barriers.  Ms Dunham is a successful actress, producer, writer, and director, having created multiple films and the wildly successful (and awesome!) HBO series Girls, both as writer/director/producer and as principal actress.  She is also a woman who did these things despite tremendous pain from endometriosis.

Read more…

Surgical Video: Resection of Rectal Endometriosis

This video discusses  a case involving partial thickness colonic/rectal endometriosis with severe pain with defecation.  The video demonstrates dissection technique for bowel mobilization and resection of the lesion, as well as generalized intraperitoneal and retroperitoneal dissection techniques.
For clinical consultation with Dr Fogelson in Portland, OR, contact Pearl Women’s Center at 503-771-1883

 

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