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Pelvic Endometriosis in a Black Virgin Adolescent in Sub-Saharan Africa

Théophile Nana Njamen*, Thomas Obinchemti Egbe1, Tchounzou Robert

Corresponding Author: Théophile Nana Njamen, Senior Lecturer, Department of Obstetrics and Gynecology, Faculty of Health Sciences, University of Buea, Cameroon

Received: March 10, 2020      Accepted: April 13, 2020      Published: July 15, 2020

Citation: Njamen TN, Egbe TO, Robert T, Nana CN, Essome H, et al. (2020) Pelvic Endometriosis in a Black Virgin Adolescent in Sub-Saharan Africa. Arch Obstet Gynecol Reprod Med, 3(2): 95-98.

Copyrights: ©2020 Benchérifa S, Amine B, El Binoune I, Hmamouchi I, Rostom S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Background: Endometriosis was formerly described as caucasian disease; with the practice of laparoscopic surgery in Africa it has been shown to concern also Black women.

Objective: To share with the researchers and clinicians a case of pelvic endometriosis in a black virgin adolescent in sub-Saharan Africa’s setting.

Case: Adolescent girl, 20 years old, virgin, managed for chronic pelvic pain with, nonsteroidal anti-inflammatory drugs, combine oral contraceptives, paracetamol and tramadol for eight months with no regression of symptoms. Laparoscopic surgery was used to diagnose and remove endometriotic tissue. Then the administration of a GnRh agonist associated with an add-back therapy permitted effective treatment of the patient.

Conclusion: Pelvic endometriosis exist in black adolescent girls in sub-saharan Africa, and must be excluded in all cases of chronic pelvic pain resistant to nonsteroidal anti-inflammatory drugs, paracetamol, combined oral contraceptives and tramadol.

 

Keywords: Endometriosis, Adolescent, Sub-saharan Africa

INTRODUCTION

Pelvic endometriosis, long considered a pathology of the Caucasian population, has also been shown to affect black women thanks to the popularization of endoscopy in sub-Saharan Africa over the past 20 years [1]. This pathology is characterized by the existence of endometriotic glandular and stromal tissue in an ectopic area [2]. Long considered a pathology for adult women, literature has proven for at least 2 decades that it is also present in adolescents, in the Caucasian population [3,4]. In presenting this clinical case we would like to share with the medical scientific community the existence of endometriosis in adolescent black girls in sub-Saharan Africa.

CASE

We are reporting a case of adolescent girl of 20 years old, nulligravid who consulted in the gynecology department of the Douala General Hospital (HGD) for chronic pelvic pain of 8 months duration, regardless of the period of the menstrual cycle, of greater intensity (quoted 8/10 on a visual analog scale [5] ) during menstruation, without improvement on antispasmodics, paracetamol, non-steroidal anti inflammatory drugs ( NSAIDs) and tramadol. Gynecological past history revealed menarche at 13 years, a regular menstrual cycle and no coitarche.

She never had a laparotomy. Her general state was good, the abdomen was soft and we did not palpate any mass. The vulva was normal, the hymen was present and the penetration of a cotton swab made it possible to verify the absence of a vaginal 

septum, agenesis of the vagina and stenosis of the cervix; digital rectal examination identified a free and non-tender rectovaginal wall and posterior cul de sac; pelvic ultrasound was normal. We sought the opinion of the gastroenterologist and the digestive surgeon who requested the following examinations (Full blood count, C Reactive Protein, Abdominal ultrasound, Stool examination) whose results were normal. MRI could not be performed because the machine was not functionning. Therefore, we suspected pelvic endometriosis : however after 3 months of monophasic low dose estrogen-progestin pill (Levonorgestrel 0.150 mg and Ethinyl oestradiol 0.030 mg) (MLOP) no improvement was observed. Hence the decision for a laparoscopy for diagnostic and possibly therapeutic purposes. After informed consent  from the patient and her parents on the importance of laparoscopy, followed by a conclusive anesthetic consultation, the operative findings were essentially: a normal but soft and hypervascularized uterus suggestive of adenomyosis; normal appendices; a hematocele of about 150 ml of dark red blood; endometriotic lesions in the pouch of douglas, uterosacral ligament and pelvic peritoneum, consisting of red, white, vesicular micronodules (from 02 to 04 mm); type A left ovaro-peritoneal adhesion [6] (Figure 1). The lesions were classified stage I [7]. The surgical procedures consisted mainly of: Biopsies of the lesions described above for histopathological analysis, aspiration of the hematocele, cauterization of residual micronodules, adhesiolysis and pelvic lavage with Ringer lactate. She came out at the 18th hour post-operation on MLOP and Celecoxib:100 mg every 12 h during 10 days. She returned for consultation on the 14th day post-operation with the result of the biopsy analysis which confirmed endometriosis; however, the pelvic pain persisted. Hence, we prescribed a GnRH agonist (Triptorelin LP 3 mg) 3 mg IM / month for 3 months in addition to the MLOP in Add back therapy. This led to a 6-month amenorrhea after the first injection and then return to a normal menstrual cycle. The patient was re-evaluated every 3 months for the two years following the surgery, a period marked by the complete regression of the pain.

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