Definition Endometriosis is the presence of functioning endometrial tissue outside the cavity of the uterus.

Dept. of Obstetrics t and Gynecology Faculty of Medicine University of Sumatera Utara

Endometriosis Definition Endometriosis is the presence of functioning endometrial tissue outside the cavity of the uterus. Incidence Twenty-one per cent of women with infertility, 15% of women with chronic abdominal pain and 6% of women undergoing sterilization have endometriosis at laparoscopy.

Age Endometriosis is most common in the 25 35 year age group, but can occur at any age from menarche until the menopause. Aetiology Various theories exist about the development of endometriosis: i Retrograde menstruation Developmental (coelomic metaplasia) Immunological.

Pathology Endometriosis usually involves deposits of endometrial tissue anywhere in the pelvis, commonly the ovaries, uterosacral ligaments or ovarian fossae. Extra-pelvic sites include operation scars, the vagina, the ureters, the bladder, the bowel, the umbilicus and, rarely, the lungs. Endometriomas (chocolate cysts) occur when the blood shed forms an encapsulated collection, usually on the ovary or in the pouch of Douglas. Adhesions are common from the monthly intraperitoneal bleeding.

Sites of Endometriosis

Investigations Laparoscopy is needed to confirm the diagnosis, which is clinical, though biopsies may be indicated for unusual appearances. Laparoscopic appearances include: Blue or black powder burn lesions Red, blue or white papular or flat lesions Peritoneal scarring and fenestrations ( peritoneal windows ) Endometriomas Frozen pelvis (fixed, immobile uterus with dense adhesions to ovaries and tubes and obliterated pouch of Douglas).

SURGERY There are two basic surgical approaches for endometriosis: Conservative Surgery (Laparoscopy or Laparotomy). Conservative surgery uses laparotomy or laparoscopy to remove the endometriosis implants without removing any other reproductive organs. Recurrence rates at two years range from 2% to 47%. Radical Surgical Therapy (Hysterectomy). Hysterectomy with removal of ovaries (oophorectomy) along with all endometrial implants is the only potential cure for endometriosis.

NORMAL PERITONEUM (SKIN COVERING THE PELVIS)

ENDOMETRIOTIC VASCULAR CHANGES-NEOVASCULARISATION PERITONEUM EARLY ENDOMETRIOTIC CHANGES AFFECTING THE BLOOD VESSELS IN SKIN COVERING THE PELVIS

ENDOMETRIOTIC PETECHIAL CHANGES PERITONEUM EARLY ENDOMETRIOTIC CHANGES PRODUCING MINUTE ARES OF HAEMORRHAGEA VESSELS IN SKIN COVERING THE PELVIS

BLEEDING AT THE TIME OF MENSTRUATION IN THE ENDOMETRIOTIC PATCH IN THE SKIN COVERING THE PELVIS

ENDOMETRIOSIS CLEAR VESICLES ENDOMETRIOSIS MAY GIVE APPEARANCE OF CLEAR BLISTERS ON THE SKIN OF THE PELVIS AND OTHER ORGAN

ENDOMETRIOTIC SCARING-PERITONEUM REPEATED BLEEDING AND HEALING IN THE SKIN OF THE PELVIS PRODUCING SCAR TISSUE

ENDOMETRIOTIC PSEUDO PERITONEAL POUCH ENDOMETRIOSIS MAY GIVE APPEARANCE AS A POUCH IN THE SKIN OF THE PELVIS

ENDOMETRIOTIC BLACK, RED AND BLUISH LESION PERITONEUM ENDOMETRIOSIS MAY GIVE APPEARANCE AS A POUCH IN THE SKIN OF THE PELVIS

ENDOMETRIOSIS OF THE OVARY PRODUCED BY BLEEDING ON THE SURFACE OF THE OVARY GIVING APPEARANCE OF BLACK SPOT

ENDOMETRIOSIS OF THE OVARY PRODUCED BY BLEEDING INSIDE THE OVARY CHOCOLATE CYST (STAGE 4)

ENDOMETRIOTIC CYSTS OF BOTH OVARIES PRODUCED BY BLEEDING INSIDE THE OVARY KISSING OVARIES (STAGE 4)

ENDOMETRIOTIC ADHESION ENDOMETRIOTIC SCARRING RESULTING IN UTERUS / OVARY STICKING (ADHESION) WITH OTHER PELVIC ORGANS (BOWEL)

ENDOMETRIOSIS ON THE SURFACE OF APPENDIX

ENDOMETRIOSIS ON THE SURFACE OF LARGE BOWEL

ENDOMETRIOSIS ON THE SURFACE OF SMALL BOWEL