EndometriosisArslan Tahir Jawad. (132)Rawalpindi Medical College-4th Year MBBS.

Definition

A condition in which actively functioning endometrial tissue and glands which are usually confined to the endometrium are found outside the uterus (ectopic endometrium).

The presence of such tissues in ectopic sites elicits inflammatory changes and fibrosis.

Symptoms

severe dysmenorrheadeep dyspareuniachronic pelvic painovulation paincyclical or perimenstrual symptoms, such as bowel or bladder, with or without abnormal bleeding or pain infertilitychronic fatiguedyschezia (pain on defaecation).

Sites

Uterine : adenomyosis (50%) Extrauterine: Ovary 30% Pelvic peritoneum 10% Fallopian tube Vagina Bladder and rectum Pelvic colon Ligaments

Morphology

Early lesions appear papular and red vesicles are filled with haemorrhagic fluid with surrounding flame like lesions.

Overtime, these vesicles change colour and endometriotic areas appear as dark red, bluish or black cystic areas adherent to the site.

Powder burnt areas

are the inactive and old lesions seen scattered over the pelvic peritoneum.

 Pelvic organs and peritoneum, although other parts of the body such as the bowel or lungs are occasionally affected.

Endometriosis - Diagnosis

2 or more of the following histologic features are criteria for Dx:

1. Endometrial epithelium 2. Endometrial glands 3. Endometrial stroma 4. Hemosiderin-laden

macrophages

Classification of Endometriosis 

Endometriosis – Medical Treatment

 Hormonal Medications 1 Combination oral contraceptive pills 2 Progestational agents 3 Gonadotropin-releasing hormone

analogues 4 Danazol (steroid)

Endometriosis - SURGERY

Surgical care can be broadly classified as 1)conservative- preserve reproductive

ability 2)semiconservative- when reproductive

ability is eliminated but ovarian function is retained

3) Radical- when the uterus and ovaries are removed

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