Transcript Endometriosis: Diagnosis Laparoscopic Images

Endometriosis: Diagnosis
Laparoscopic Images
Laparoscopic Images
2
Laparoscopic Images
3
Laparoscopic Images
4
Endometriosis: Case Studies
Case studies and clinical pictures were kindly provided by
Dr. Cordula von Kleinsorgen and Prof. Dr. Dr. Dr.h.c. Andreas D. Ebert
Endometriosis Centre Berlin (EndoCB)
Department of Obstetrics and Gynecology, Vivantes Humboldt-Klinikum,
Berlin, Germany
I) Diffuse peritoneal endometriosis
• History:
– 36y, G0 P0; OC use (continuous)
– During routine gynecological examination diagnosis of ovarian cysts
– Primary dysmenorrhea, mild menorrhagia, sporadic sick leave due to
dysmenorrhea also with vomiting and fatigue symptoms
6
I. Diffuse peritoneal endometriosis
Uterus
•
•
Uterus with adenomyosis uteri
Appearance of prominent vessels on fallopian tubes, bladder, peritoneum and parametrial area
7
I. Diffuse peritoneal endometriosis
View of pouch of Douglas. Filmy adhesions with endometriotic lesions
8
I. Diffuse peritoneal endometriosis
•
Scar tissue from endometriotic lesions
9
I. Diffuse peritoneal endometriosis
•
Post surgery. Light areas are coagulated endometriotic lesions
10
I. Diffuse peritoneal endometriosis
• Diagnosis:
– Endometriosis rASRM III (18 points) with obliteration of pouch of Douglas
– Adenomyosis uteri
11
II. Endometrioma
• History:
– 25 yrs, G0 P0, post laparotomy due to endometriotic cyst (left
ovary)
– Presents 6 months later with new cystic lower abdominal mass.
Light pelvic pain, perimenstrual bloating, primary dysmenorrhea
– Regular menstrual cycle, recently switched to Valette
(previously on cyclic Monostep – no OC prior to Jul 09)
– Wishes to conceive in the future
12
II. Endometrioma
uterus
endometrioma
Pelvic cavity: large endometrioma and uterus with fallopian tubes
13
II. Endometrioma
endometrioma
14
II. Endometrioma
endometrioma
fallopian tube
fimbriae
Right fallopian tube, fimbriae adherent to cyst
15
II. Endometrioma
uterus
right
adnexal
structures
Site after removal of the endometrioma
16
III. Obliteration of the pouch of
Douglas
• History:
– 42 yrs, G1 P1, presents in Sept 2009
– Primary dysmenorrhea, menorrhagia days 1-3 (> 5 pads/day).
Premenstrual polyuria and diarrhea, perimenstrual bloating,
dyspareunia (sexual position dependent).
– 2x laparoscopy for endometriosis. Postoperative use of POP
(Cerazette) (until July 09) with side effects of spotting and
weight gain
– After cessation of POP: cycle irregularities July-Sept 09
17
III. Obliteration of the pouch of
Douglas
uterus
Enlarged uterus with obliteration of the pouch of Douglas
18
III. Obliteration of the pouch of
Douglas
Conglomerate
tumor
Conglomerate tumor (comprising uterus, ovary and bowel with adhesions)
19
III. Obliteration of the pouch of
Douglas
adenomyosis
Fixed uterus with prominent adenomyosis
20
III. Obliteration of the pouch of
Douglas
postoperative
mobilisation
Laparoscopic view after vaginal hysterectomy with removal of right adnexal structures
21
IV. Bladder endometriosis
• History:
– 32 yrs (G0 P0) with history of bladder endometriosis (transurethral
resection in 2008 with recurrence in 2009)
– Primary dysmenorrhea since age of 14. PMS with midcycle bleeding.
Dyspareunia (cycle dependent, position independent) with loss of
libido
– Presents with spotting, dysuria during menstruation, recurrent
diarrhea (not related to cycle), left pelvic swelling with menstruation.
– Current wish to conceive
22
IV. Bladder endometriosis
Cystoscopy with bladder endometriosis
23
IV. Bladder endometriosis
uterus
Pelvic area with bladder endometriosis, adhesions of bladder and uterus
24
IV. Bladder endometriosis
bladder
Incision of the bladder
25
IV. Bladder endometriosis
bladder
endometriosis
Removal of the lesion
26
IV. Bladder endometriosis
bladder
Resealed bladder
27
V. Rectovaginal endometriosis
• History:
– 29 yrs, G0 P0, presents with cyclic pelvic pain
– Diarrhea, secondary dysmenorrhea, dyspareunia with loss of
libido, stool irregularities with menstruation
– Current wish to conceive in the near-mid future
28
V. Rectovaginal endometriosis
uterus
bowel endometriosis
Deep infiltrating bowel endometriosis
29
V. Rectovaginal endometriosis
bowel endometriosis
Mobilisation of rectum, bowel endometriosis
30
V. Rectovaginal endometriosis
anastomosis
Creating an anastomosis after anterior rectum resection
31
V. Rectovaginal endometriosis
anastomosis
Pelvic region after anterior rectum resection
32
VI. Diaphragmatic endometriosis
• History:
– 28 yrs, G0 P0, pelvic endometriosis diagnosed in 2007
– Presents with increasing pain in right shoulder and skin hypoesthesia
with menstruation. Primary dysmenorrhea with headache. Position
dependent dyspareunia
•
33
VI. Diaphragmatic endometriosis
diaphragm
liver
Abdominal view of liver and diaphragm
34
VI. Diaphragmatic endometriosis
diaphragmatic endometriosis
Endometriotic lesions
35
VI. Diaphragmatic endometriosis
removal of peritoneum
After excision of lesions
36
VI. Diaphragmatic Endometriosis
Adenomyosis and peritoneal endometriosis
37