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ENDOMETRIOSIS

It is a condition that occurs when tissue similar to the inside lining of the uterus is found outside of its normal location. Endometrial implants can be found on the ovaries, fallopian tubes, and ligaments that support the uterus and tissue covering the bladder and rectum. The most common locations of endometrial implants in teens are in the cul–de–sac area (behind the uterus), and near the bladder.

What causes endometriosis?

The exact cause is not known. It is thought that some cells from the womb (uterus) lining (the endometrium) get outside the uterus through the tubes by retrograde flow into the pelvic area. The ‘spilt’ endometrial cells then continue to survive next to the uterus, ovary, bladder, bowel, or Fallopian tube or even on previous scars like that of caesarean section. The cells respond to the female hormone oestrogen, just like the lining of the uterus does each month. Throughout each month the cells multiply and swell, and then break down as if ready to be shed at the time of your period. However, because they are trapped inside the pelvic area, they cannot escape. They form patches of tissue called endometriosis. Patches of endometriosis tend to be adhesion forming and may hence join organs to each otherlike bowel to the uterus, omentum to the uterus, ovaries and uterus etc.The cysts can fill with dark blood; this is known as ‘chocolate cysts’.

With each menstrual cycle, the implants go through the same growing, breaking down, and bleeding that the uterine lining (endometrium) goes through. This is why endometriosis pain may start as mild discomfort a few days before the menstrual period and then usually is gone by the time the period ends. But if an implant grows in a sensitive area, it can cause constant pain or pain during certain activities, such as sex, exercise, or bowel movements.
Between 20% and 40% of women who are infertile have endometriosis.

Pain is the main symptom of endometriosis. You may have:

  • • Painful periods
  • • Pain prior to and after menses
  • • Pain during or following sexual intercourse
  • • Pain with bowel movements
  • • Pelvic or low back pain that may occur at any time Best methods for diagnosis:

  • • Transvaginal ultrasound
  • • Pelvic laparoscopy

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CHOCOLATE CYST ON ULTRASOUND

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CHOCOLATE CYST ON ULTRASOUND

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CHOCOLATE CYST OF OVARY DURING LAPAROSCOPY

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LAPAROSCOPIC CHOCOLATE CYSTECTOMY

WHAT IS THE TREATMENT?

ORAL CONTRACEPTIVE PILLS
LIFESTYLE MODIFICATION
NSAIDS
ANTIFIBRINOLYTIC AGENTS

SURGERY:

  • 1. YOUNG PATIENTS : IF SYMPTOMATIC CAUSING PAIN AND OTHER SYMPTOMS, THEN OVARIAN CYSTECTOMY ( REMOVAL OF ONLY THE CYSTWALL AND ALTERED OLD BLOOD, NOT THE OVARY)
  • 2. BELOW 40 YEARS COMPLETED FAMILY:SALPINGOOPHERECTOMY ( REMOVAL OF FALLOPIAN TUBE AND OVARY)
  • 3. ABOVE 40 YEARS : HYSTERECTOMY AND BILATERAL SALPINGOOPHERECTOMY ( REMOVAL OF UTERUS AND BOTH TUBES AND OVARIES)