An alternative laparoscopic entry site in a case of recurrent stage IV pelvic endometriosis

Atef M Darwish; Dina A Darwish; Amany S Omer; Atef M Darwish; Dina A Darwish; Amany S Omer

doi:10.3934/medsci.2026004

AIMS Medical Science

2026, Volume 13, Issue 1: 50-56. doi: 10.3934/medsci.2026004

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Case report

An alternative laparoscopic entry site in a case of recurrent stage IV pelvic endometriosis

Running title: Stage four endometriosis

1.
Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt
2.
Department of Obstetrics and Gynecology, Al Emadi Hospital, Doha, Qatar
3.
Obstetrics and Gynecology Department, Woman's Health Hospital, Assiut University, Assiut, Egypt
4.
Department of Pathology, AL Emadi Hospital, Doha, Qatar

Received: 27 September 2025 Revised: 24 February 2026 Accepted: 17 March 2026 Published: 20 March 2026

Stage IV pelvic endometriosis poses significant surgical challenges. When umbilical access is deemed high-risk, alternative non-umbilical laparoscopic entry points may be considered. Currently, there is no consensus on the safest or most ideal alternative non-umbilical access site. We report a case of Stage IV pelvic endometriosis accompanied by severe pelvic pain, in which a novel right-sided, alternative non-umbilical laparoscopic entry was successfully employed. This approach was selected due to the presence of retro-umbilical adhesions, a large left-sided ovarian endometrioma, a tubo-ovarian mass, and left-sided hydrosalpinx. The surgical technique and postoperative recovery are detailed, demonstrating favorable outcomes. In selected cases of Stage IV pelvic endometriosis, particularly those with left-sided adnexal pathology, the right-sided “Darwish point” may offer a relatively safe and effective non-umbilical alternative for laparoscopic access. Further studies are needed to validate its safety and efficacy before this entry site can be widely recommended.
- endometriosis,
- laparoscopy,
- left,
- Darwish,
- entry,
- case report,
- pelvic colon
Citation: Atef M Darwish, Dina A Darwish, Amany S Omer. An alternative laparoscopic entry site in a case of recurrent stage IV pelvic endometriosis[J]. AIMS Medical Science, 2026, 13(1): 50-56. doi: 10.3934/medsci.2026004

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Abstract

Stage IV pelvic endometriosis poses significant surgical challenges. When umbilical access is deemed high-risk, alternative non-umbilical laparoscopic entry points may be considered. Currently, there is no consensus on the safest or most ideal alternative non-umbilical access site. We report a case of Stage IV pelvic endometriosis accompanied by severe pelvic pain, in which a novel right-sided, alternative non-umbilical laparoscopic entry was successfully employed. This approach was selected due to the presence of retro-umbilical adhesions, a large left-sided ovarian endometrioma, a tubo-ovarian mass, and left-sided hydrosalpinx. The surgical technique and postoperative recovery are detailed, demonstrating favorable outcomes. In selected cases of Stage IV pelvic endometriosis, particularly those with left-sided adnexal pathology, the right-sided “Darwish point” may offer a relatively safe and effective non-umbilical alternative for laparoscopic access. Further studies are needed to validate its safety and efficacy before this entry site can be widely recommended.

Data availability statement

The data supporting the findings of this case report are available within the article. Additional clinical details are not publicly available in order to protect patient privacy and confidentiality. Further inquiries can be directed to the corresponding author.

Ethical approval of the research and informed consent

Institutional Review Board (IRB) approval (IRB No. PAT0255960). A written consent to do the procedure and to publish the case was given by the patient.

Conflict of interest

The authors declare no conflict of interest.

References

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