Endometriosis and Laparoscopy

Endometriosis and Laparoscopy

 Findings at Laparoscopy

ORGANS AT RISK

 

  1. Common organ involvement corresponds to those organs bathed in pelvic peritoneal fluid.

 

  1. Bladder
  2. Round ligaments
  3. Uterus
  4. Uterosacral ligaments
  5. Broad ligaments
  6. Ovaries
    1. Fallopian tubes
    2. Lateral pelvic peritoneum
    3. Rectovaginal pouch j. Rectum
    4. Sigmoid colon
    5. Cecum
    6. Appendix
    7. Distal ileum

 

Uncommon organ involvement

  1. Episiotomy
  2. Transverse colon
  1. Sciatic nerve
    1. Trigone of bladder
    2. Lung

 

  1. Rare organ involvement
    1. Pancreas
    2. Liver
    3. Brain
    4. Skin

 

ASYMMETRY

 

  1. 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.
  2. Lateral asymmetry: Endometriosis tends to be more severe on one side of the pelvis, with sparing or relative sparing of the other side.

 

INVASION

 

  1. Endometriosis elicits a foreign body reaction, fibrosis, to encapsulate and contain the disease.
  2. Deep nodules form in the rectovaginal pouch and uterosacral ligaments.
  3. Endometriotic cysts form in the ovaries.

 

ACUTE AND CHRONIC ENDOMETRIOSIS

 

  1. Acute endometriosis: exhibits red, angry, inflammatory host response to ruptured ovarian endometrioma, or aggressively active disease
  2. Chronic endometriosis: exhibits firm, enveloping fibrosis in a quies­cent pelvis

 

PERITONEAL POCKETS WITH ENDOMETRIOSIS

 

  1. Located in broad ligaments and rectovaginal pouch of Douglas
  2. Associated medial displacement of ureter(s) in some cases
  3. Endometriosis presents as tan brim nodules and spider lesions

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