{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:05:45Z","timestamp":1760148345804,"version":"build-2065373602"},"reference-count":50,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,4,23]],"date-time":"2023-04-23T00:00:00Z","timestamp":1682208000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: A peculiar complication of endometriosis is a superinfection. However, the superinfection of extra-ovarian endometriosis is anecdotal, and only a few cases have been described. We wanted to present the first cases of the superinfection of rectovaginal endometriosis and to perform a literature review of the superinfection of extra-ovarian endometriosis. Methods: We present a case of a 24-year-old woman who was referred to our Pelvic Floor Unit for rectal\u2013perineal pain, dyspareunia, and recurrent episodes of dense purulent vaginal discharge for one year, in which the superinfection of rectovaginal endometriosis was diagnosed. Moreover, we performed a systematic search of the literature indexed on PubMed up to 31 January 2023. Results: Laparoscopic drainage was successful in managing this condition. In the literature, clinical presentation and instrumental and microbiological findings are very heterogeneous. However, the gold standard of management is represented by surgical or percutaneous drainage. Conclusions: In the case of a pelvic abscess, the superinfection of endometriosis lesions should be suspected, and this can represent the onset symptom of endometriosis. Ultrasonography may show nodular or flat hypoechoic lesions with hyperechoic debris and peripheral positive color\/power Doppler intensities. The goal of management is to drain the abscess, either percutaneously or via traditional surgery, followed by proper hormonal therapy to reduce recurrence.<\/jats:p>","DOI":"10.3390\/diagnostics13091514","type":"journal-article","created":{"date-parts":[[2023,4,24]],"date-time":"2023-04-24T01:35:44Z","timestamp":1682300144000},"page":"1514","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Superinfection of Rectovaginal Endometriosis: Case Report and Review of the Literature"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7495-7185","authenticated-orcid":false,"given":"Marta","family":"Barba","sequence":"first","affiliation":[{"name":"Department of Gynecology and Obstetrics, Pelvic Floor Center, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5420-4277","authenticated-orcid":false,"given":"Andrea","family":"Morciano","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Panico Pelvic Floor Center, Pia Fondazione \u201cCardinale G. Panico\u201d, 73039 Tricase, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomaso","family":"Melocchi","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Pelvic Floor Center, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alice","family":"Cola","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Pelvic Floor Center, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7532-3267","authenticated-orcid":false,"given":"Alessandra","family":"Inzoli","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Passoni","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, ASST Monza, Ospedale San Gerardo, 20900 Monza, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3952-8462","authenticated-orcid":false,"given":"Matteo","family":"Frigerio","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Pelvic Floor Center, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,4,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1056\/NEJMra0804690","article-title":"Endometriosis","volume":"360","author":"Bulun","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/j.ogc.2012.10.002","article-title":"Endometriosis and Infertility","volume":"39","author":"Macer","year":"2012","journal-title":"Obstet. Gynecol. Clin. N. Am."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1016\/S0015-0282(01)02998-3","article-title":"Diaphragmatic endometriosis: Diagnosis, surgical management, and long-term results of treatment","volume":"77","author":"Redwine","year":"2002","journal-title":"Fertil. Steril."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1016\/S0889-8545(05)70311-9","article-title":"Extrapelvic endometriosis","volume":"24","author":"Jubanyik","year":"1997","journal-title":"Obstet. Gynecol. Clin. N. Am."},{"key":"ref_5","unstructured":"Taylor, H.S., Fritz, M.A., Pal, L., and Seli, E. (2020). Speroff\u2019s Clinical Gynecologic Endocrinology and Infertility, Wolters Kluwer. [9th ed.]."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.1016\/S0140-6736(04)17403-5","article-title":"Endometriosis","volume":"364","author":"Giudice","year":"2004","journal-title":"Lancet"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1080\/01443610400009568","article-title":"Extragenital endometriosis\u2014A clinicopathological review of a Glasgow hospital experience with case illustrations","volume":"24","author":"Douglas","year":"2004","journal-title":"J. Obstet. Gynaecol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1016\/S0015-0282(02)03342-3","article-title":"Characteristics of patients with endometriosis in the United States and the United Kingdom","volume":"78","author":"Kuohung","year":"2002","journal-title":"Fertil. Steril."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"44","DOI":"10.3928\/00904481-19811201-07","article-title":"Endometriosis in young teen-age girls","volume":"10","author":"Huffman","year":"1981","journal-title":"Pediatr. Ann."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1080\/13697137.2019.1578743","article-title":"Diagnosis of endometriosis in the 21st century","volume":"22","author":"Kiesel","year":"2019","journal-title":"Climacteric"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1038\/nrendo.2013.255","article-title":"Endometriosis: Pathogenesis and treatment","volume":"10","author":"Vercellini","year":"2014","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"102228","DOI":"10.1016\/j.jogoh.2021.102228","article-title":"Adenomyosis: An update regarding its diagnosis and clinical features","volume":"50","author":"Bourdon","year":"2021","journal-title":"J. Gynecol. Obstet. Hum. Reprod."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1007\/s12325-018-0667-3","article-title":"Real-World Evaluation of Direct and Indirect Economic Burden among Endometriosis Patients in the United States","volume":"35","author":"Soliman","year":"2018","journal-title":"Adv. Ther."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1016\/j.fertnstert.2018.10.013","article-title":"Pathogenesis of endometriosis: The genetic\/epigenetic theory","volume":"111","author":"Koninckx","year":"2018","journal-title":"Fertil. Steril."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/j.jmig.2019.10.004","article-title":"Extrapelvic Endometriosis: A Systematic Review","volume":"27","author":"Andres","year":"2019","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1097\/GRF.0b013e3181e0ea6e","article-title":"Extragenital Endometriosis","volume":"53","author":"Veeraswamy","year":"2010","journal-title":"Clin. Obstet. Gynecol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1080\/13625187.2019.1662391","article-title":"Recurrent endometriosis: A battle against an unknown enemy","volume":"24","author":"Ceccaroni","year":"2019","journal-title":"Eur. J. Contracept. Reprod. Health Care"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Hart, R.J., Hickey, M., Maouris, P., and Buckett, W. (2008). Excisional surgery versus ablative surgery for ovarian endometriomata. Cochrane Database Syst Rev., CD004992.","DOI":"10.1002\/14651858.CD004992.pub3"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.rbmo.2010.04.018","article-title":"Post-operative endometriosis recurrence: A plea for prevention based on pathogenetic, epidemiological and clinical evidence","volume":"21","author":"Vercellini","year":"2010","journal-title":"Reprod. Biomed. Online"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1016\/j.fertnstert.2015.08.026","article-title":"Prevention of the recurrence of symptom and lesions after conservative surgery for endometriosis","volume":"104","author":"Koga","year":"2015","journal-title":"Fertil. Steril."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1093\/humupd\/dmv045","article-title":"A systematic review on endometriosis during pregnancy: Diagnosis, misdiagnosis, complications and outcomes","volume":"22","author":"Maggiore","year":"2015","journal-title":"Hum. Reprod. Updat."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1111\/j.1447-0756.1997.tb00867.x","article-title":"A Study of Tubo-Ovarian and Ovarian Abscesses, with a Focus on Cases with Endometrioma","volume":"23","author":"Kubota","year":"1997","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/S0015-0282(16)45613-X","article-title":"Infected Endometriotic Cysts: Clinical Characterization and Pathogenesis","volume":"36","author":"Schmidt","year":"1981","journal-title":"Fertil. Steril."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.clinimag.2019.06.012","article-title":"Percutaneous drainage of an infected endometrioma","volume":"58","author":"Fenster","year":"2019","journal-title":"Clin. Imaging"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1710","DOI":"10.1007\/s43032-021-00745-6","article-title":"Stem Cells in Clinical Trials for Pelvic Floor Disorders: A Systematic Literature Review","volume":"29","author":"Manodoro","year":"2021","journal-title":"Reprod. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1016\/j.ejogrb.2020.11.054","article-title":"Obstetric outcomes after uterus-sparing surgery for uterine prolapse: A systematic review and meta-analysis","volume":"256","author":"Barba","year":"2020","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1007\/s00192-022-05270-x","article-title":"Hematocolpos due to imperforate hymen: A case report and literature systematic review","volume":"34","author":"Marino","year":"2022","journal-title":"Int. Urogynecol. J."},{"key":"ref_28","first-page":"65","article-title":"Female Genital Hair-Thread Tourniquet Syndrome: A Case Report and Literature Systematic Review","volume":"34","author":"Barba","year":"2020","journal-title":"J. Pediatr. Adolesc. Gynecol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1002\/ijgo.13950","article-title":"Risk factors for obstetric anal sphincter injury recurrence: A systematic review and meta-analysis","volume":"158","author":"Barba","year":"2021","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1002\/ijgo.14137","article-title":"Pelvic organ prolapse and vaginal cancer: A systematic literature review","volume":"159","author":"Frigerio","year":"2022","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_31","first-page":"931","article-title":"Pelvic endometriosis presenting as a Supralevator abscess","volume":"80","author":"Anderson","year":"1988","journal-title":"J. Natl. Med. Assoc."},{"key":"ref_32","first-page":"238156","article-title":"Abscessed Uterine and Extrauterine Adenomyomas with Uterus-Like Features in a 56-Year-Old Woman","volume":"2013","author":"Bulut","year":"2013","journal-title":"Case Rep. Obstet. Gynecol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Cheng, C.-H., Kuo, H.-C., and Su, B. (2015). Endometriosis in a kidney with focal xanthogranulomatous pyelonephritis and a perinephric abscess. BMC Res. Notes, 8.","DOI":"10.1186\/s13104-015-1574-1"},{"key":"ref_34","first-page":"275","article-title":"Tuba ovarian abscesses formation from decidualized ovarian endometrioma after appendiceal endometriosis presenting as acute appendicitis in pregnancy","volume":"10","author":"Dogan","year":"2012","journal-title":"Iran. J. Reprod. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1155\/S1064744903000085","article-title":"Abscess in Adenomyosis Mimicking a Malignancy in a 54-Year-Old Woman","volume":"11","author":"Erguvan","year":"2003","journal-title":"Infect. Dis. Obstet. Gynecol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"252","DOI":"10.4103\/GMIT.GMIT_12_20","article-title":"A case of an abscessed cystic endometriotic lesion in the vesico-uterine pouch after oocyte retrieval","volume":"10","author":"Matsuda","year":"2021","journal-title":"Gynecol. Minim. Invasive Ther."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Oda, K., Ikeda, Y., Maeda, D., Arimoto, T., Kawana, K., Fukayama, M., Osuga, Y., and Fujii, T. (2014). Huge pyogenic cervical cyst with endometriosis, developing 13 years after myomectomy at the lower uterine segment: A case report. BMC Women\u2019s Health, 14.","DOI":"10.1186\/1472-6874-14-104"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e129","DOI":"10.1055\/s-0040-1708849","article-title":"Peritoneovaginal Fistula and Appendicitis-Related Pelvic Abscess in Pregnancy","volume":"10","author":"Saleh","year":"2020","journal-title":"Am. J. Perinatol. Rep."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1177\/1066896914534465","article-title":"Hepatic Uterus-Like Mass Misdiagnosed as Hepatic Abscess","volume":"23","author":"Sopha","year":"2014","journal-title":"Int. J. Surg. Pathol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1016\/j.jmig.2018.03.036","article-title":"A Case of Psoas Muscle Endometriosis: A Distinct Approach to Diagnosis and Management","volume":"25","author":"Zhao","year":"2018","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1093\/humupd\/dmt027","article-title":"The social and psychological impact of endometriosis on women\u2019s lives: A critical narrative review","volume":"19","author":"Culley","year":"2013","journal-title":"Hum. Reprod. Updat."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/j.ijgo.2007.03.043","article-title":"Appendiceal endometriosis presenting as acute appendicitis during pregnancy","volume":"98","author":"Perez","year":"2007","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1007\/s001040051019","article-title":"Deciduosis of the appendix. Differential diagnosis of acute appendicitis","volume":"71","author":"Hauptmann","year":"2000","journal-title":"Chirurg"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1080\/01443615.2018.1529153","article-title":"Salmonella enteritidis during pregnancy, a rare cause of septic abortion: Case report and review of the literature","volume":"39","author":"Delcourt","year":"2018","journal-title":"J. Obstet. Gynaecol."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Scioscia, M., Virgilio, B.A., Lagan\u00e0, A.S., Bernardini, T., Fattizzi, N., Neri, M., and Guerriero, S. (2020). Differential Diagnosis of Endometriosis by Ultrasound: A Rising Challenge. Diagnostics, 10.","DOI":"10.3390\/diagnostics10100848"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1046\/j.1469-0705.1998.12010056.x","article-title":"Transvaginal sonographic markers of tubal inflammatory disease","volume":"12","author":"Lerner","year":"1998","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_47","unstructured":"Volont\u00e8, S., Manodoro, S., and Frigerio, M. (2022). Handbook of Pelvic Floor Ultrasound, Independently Published."},{"key":"ref_48","first-page":"426","article-title":"Pelvic floor ultrasonography for the evaluation of the rectum-vaginal septum before and after prolapse native-tissue repair","volume":"72","author":"Barba","year":"2021","journal-title":"Minerva Obstet. Gynecol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.1007\/s00192-012-2031-5","article-title":"Three-dimensional ultrasound assessment and middle term efficacy of a single-incision sling","volume":"24","author":"Spelzini","year":"2013","journal-title":"Int. Urogynecol. J."},{"key":"ref_50","first-page":"642","article-title":"Novel sonographic method for the evaluation of the defects in the pubocervical fascia in patients with genital prolapse","volume":"70","author":"Manodoro","year":"2018","journal-title":"Minerva Obstet. Gynecol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/9\/1514\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:21:36Z","timestamp":1760124096000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/9\/1514"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,23]]},"references-count":50,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2023,5]]}},"alternative-id":["diagnostics13091514"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics13091514","relation":{},"ISSN":["2075-4418"],"issn-type":[{"type":"electronic","value":"2075-4418"}],"subject":[],"published":{"date-parts":[[2023,4,23]]}}}