Findings at Laparoscopy
ORGANS AT RISK
- Common organ involvement corresponds to those organs bathed in pelvic peritoneal fluid.
- Round ligaments
- Uterosacral ligaments
- Broad ligaments
- Fallopian tubes
- Lateral pelvic peritoneum
- Rectovaginal pouch j. Rectum
- Sigmoid colon
- Distal ileum
Uncommon organ involvement
- Transverse colon
- Sciatic nerve
- Trigone of bladder
- Rare organ involvement
- Anteroposterior asymmetry: Endometriosis is common in the vesicouterine pouch when the uterus is sharply anteverted, and in the rectovaginal pouch when the uterus is retroverted.
- Lateral asymmetry: Endometriosis tends to be more severe on one side of the pelvis, with sparing or relative sparing of the other side.
- Endometriosis elicits a foreign body reaction, fibrosis, to encapsulate and contain the disease.
- Deep nodules form in the rectovaginal pouch and uterosacral ligaments.
- Endometriotic cysts form in the ovaries.
ACUTE AND CHRONIC ENDOMETRIOSIS
- Acute endometriosis: exhibits red, angry, inflammatory host response to ruptured ovarian endometrioma, or aggressively active disease
- Chronic endometriosis: exhibits firm, enveloping fibrosis in a quiescent pelvis
PERITONEAL POCKETS WITH ENDOMETRIOSIS
- Located in broad ligaments and rectovaginal pouch of Douglas
- Associated medial displacement of ureter(s) in some cases
- Endometriosis presents as tan brim nodules and spider lesions