For years, Nabila W. lived with pain that defied explanation. What began as just “painful periods” in her teens escalated into debilitating monthly episodes that left her physically and emotionally drained. Despite multiple doctor visits, scans, and procedures, no one could pinpoint the cause. She was told it might be anxiety, depression, or even drug use—none of which were true.
It wasn’t until a dramatic health collapse in late 2024 that Nabila finally received a diagnosis: endometriosis, a chronic condition where tissue similar to the uterine lining grows outside the uterus, causing inflammation, pain, and sometimes infertility.
A Diagnosis—and a Turning Point
While visiting family in Indonesia, Nabila underwent surgery to remove what was believed to be a ruptured ovarian cyst. But the procedure revealed something far more serious: her pelvic organs were fused together by dense scar tissue, and she had Stage IV endometriosis—the most severe form of the disease, marked by widespread adhesions and deep infiltrating lesions.
They told me, ‘That took three hours. Your insides were all glued together. Your endometriosis is very severe.’
Deciding on a Treatment Plan
At ESSE Care, Nabila underwent a full evaluation, including MRI imaging to get a detailed view of her pelvis. The results showed:
- Endometriomas (blood-filled cysts caused by endometriosis) in both ovaries
- Deep infiltrating endometriosis in the rectovaginal septum (the tissue between the rectum and vagina)
- Extensive peritoneal adhesions—bands of scar tissue that bind organs together, often causing pain and dysfunction
To reduce inflammation and lesion size, Nabila completed a three-month course of GnRH agonist therapy, a hormone treatment that temporarily suppresses ovarian function. But her symptoms persisted, and she and Dr. Goldstein decided it was time to schedule excision surgery.
When the surgical team entered Nabila’s abdominal cavity laparoscopically (using small incisions and a camera), they encountered a “frozen pelvis”—a term used when pelvic organs are stuck together by scar tissue, making movement and function difficult.
Step 1: Adhesiolysis—Freeing the Organs
The first challenge was adhesiolysis, the careful cutting and removal of adhesions. Using sharp dissection (precise cutting with surgical instruments) and cautery (heat-based tools to cut and stop bleeding), the team separated the uterus, bladder, and bowel, restoring their normal positions and mobility.
Step 2: Ovarian Cyst Removal
Both ovaries were affected by large endometriomas, 5-6 cm in diameter, with the right ovary showing signs of significant distortion due to the size of the cysts. These cysts were excised while preserving healthy ovarian tissue—a critical step for maintaining fertility.
Step 3: Excision of Endometrial Lesions
The team identified and removed multiple endometrial implants—patches of rogue tissue—on the peritoneum (the lining of the abdominal cavity), pelvic sidewalls, and the posterior cul-de-sac (the space behind the uterus). These were removed with careful excision surgery and meticulous hemostasis (bleeding control).
Step 4: Deep Lesion Management
The rectovaginal septum was deeply infiltrated with endometrial tissue. Resection here required extreme precision to avoid damaging the bowel or vaginal wall. The ESSE Care team collaborated with other surgical specialists to ensure safe and complete removal.
Pathology and Confirmation
Tissue samples confirmed the diagnosis:
- Ovarian cysts contained thick, brown fluid typical of endometriomas
- Peritoneal biopsies showed endometrial glands and stroma (supportive tissue) embedded in the peritoneum
- No signs of cancer were found
Recovery and Results
Nabila’s recovery was smooth. She was discharged just two days after surgery and began a regimen focused on:
- Pain management, which brought immediate relief
- Gentle movement, physical therapy, and a gradual return to normal activities
- Follow-up visits at 1, 3, and 6 months
The surgery marked a turning point—not just physically, but emotionally. For the first time, Nabila felt heard, validated, and supported.
I know now that if I have concerns, there’s a team I can reach out to of women who will take me seriously. And I don’t have to worry about being dramatic or bothering anyone. They've given me a community and a safe place to navigate this illness and this journey to wellness, and I'm really, really thankful for that.
Why This Matters
Endometriosis is a disease that often goes undetected for years, leaving patients to suffer in silence. Nabila’s story is a stark example of how misdiagnoses, medical dismissal, and lack of specialized care can delay effective treatment and erode a person’s trust in their own body. Her journey underscores the critical need for expert excision surgery and a care team that listens, believes, and acts.
This story is also a reminder that not all gynecologic surgeries are the same. Excision surgery—especially for advanced cases—requires a specialized skill set, a multidisciplinary team, and a commitment to listening to the patient. For those suffering in silence, the right care can be transformative.
Dr. Goldstein’s Final Thoughts: The Importance of Empathy
By the time many patients reach us, they’ve endured years of pain, misdiagnoses, and gaslighting. Our job isn’t just to operate—it’s to listen, to believe them, and to treat the disease with the precision it demands. Nabila’s case is a powerful reminder that expert care can change everything.
Through meticulous surgical technique and a patient-first approach, ESSE Care helped Nabila reclaim her health and her hope.
Ready to experience our compassionate approach to endometriosis care? Reach out today for a case review.
