Six years ago, Neriza Imatong Banggawan was diagnosed with endometriosis, unaware of the significant impact this debilitating disease would have on her body. In 2017, she underwent surgery after being diagnosed with a small cyst on her left ovary.
“After the surgery, I didn’t do any follow-up checkups. Two years later, I started suffering from severe back pain, especially during my menstrual cycles,” said Banggawan, a Filipina who has been living in the UAE since 2010. Soon, she started dreading her periods, during which she would experience crippling pain accompanied by a bloated stomach, nausea, and vomiting.
After suffering from the pain for some time, Banggawan sought treatment at Burjeel Medical City; endometriosis had taken a severe toll on her body. Dr Sandesh Kade, a gynaecologist surgeon (specialist in laparoscopic, endometriosis and pelvic floor repair surgeries), discovered that her condition had advanced to such an extent that she now faced the loss of one of her kidneys and a portion of her bowel.
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Endometriosis, a condition that affects millions of women worldwide, is a chronic disease that occurs when tissue similar to the lining of the uterus grows outside the uterus. It is considered a full-body disease that commonly affects organs in the pelvis, pouch of Douglas, bowel, and bladder.
Dr Kade said that the delayed diagnosis had allowed the ovarian endometriosis to progress unchecked, leading to life-altering consequences. “The MRI revealed that apart from her uterus and ovaries being affected, the endometriosis had severely affected her left kidney and multiple sites of the bowel. We had no choice but to remove her left kidney, which appeared not to be functioning for a long time, and some parts of her bowel. Had the problem not been ignored for years, it wouldn’t have reached this stage,” said Dr Kade.
The management of endometriosis depends upon various factors like the stage of disease, age of the patient, married status, intention for pregnancies, pain, bleeding, and fertility issues. A radical surgery like this would require a multidisciplinary approach from a team comprising a urologist, a gynaecologist, and a gastrointestinal surgeon. As Banggawan is unmarried and wants to have children in the future, preserving her fertility was also a priority.
The six-hour-long laparoscopic (with only small skin incisions) procedure was performed by multiple surgeons from different departments in one sitting. Dr Kade removed the adhesions to open all the spaces in the pelvis and separate the bowel and bladder from the diseased tissue. He then excised the endometriosis from several places in the pelvis and removed the left fallopian tube and ovary because they were completely affected by the disease. After this, Dr Maciej Szwedowski, consultant, urology and uro-oncology, removed the patient’s destroyed left kidney and dilated ureter. “We knew that even after removing the endometriosis and bringing back the flow of urine to the bladder, her kidney would not start working again. It would just be a possible source of pain and infections,” said Dr Szwedowski adding that the patient will have to be on continuous treatment to prevent the progression of the disease.
Dr Ali Iyoob Valiyaveettil, consultant and head, of gastrointestinal surgery, then completed the surgery. “As the endometriosis had affected the patient’s bowel in three places, I had to remove parts of the rectum and appendix, cecum, and small bowel. Often when there is so much resection, the patient would require a colostomy. However, she sailed through and did not need the colostomy,” said Dr Valiyaveettil.
According to doctors, with her uterus and one ovary preserved, Banggawan can plan to have children in the future.
As she continues her recovery journey, she is glad to find relief from the pain. By sharing her story, Banggawan hopes other women will be encouraged to seek help promptly. “I’m feeling good after my surgery. The doctor has advised monthly check-ups, every 6 months ultrasound scans, and yearly MRIs. I advise other women not to wait and instead seek early diagnosis for painful periods. Get timely treatment to avoid complications,” Banggawan said.
According to Dr Kade, endometriosis is often undiagnosed. “There is no technique to prevent endometriosis. We can offer early diagnosis and correct treatment before any organ damage. This disease can affect girls and women between the ages of 13-50. Ignorance on the part of doctors and the pressure to accept period pain are some of the factors that lead to a delay in diagnosis and women suffering this pain for many years,” said Dr Kade, reiterating the importance of early detection and intervention.
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