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Endometriosis. What is endometriosis and when is laparoscopy done?

Endometriosis. What is endometriosis and when is laparoscopy done?



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Endometriosis is a gynecological disorder, quite common, found in about 10-20% of women of reproductive age.

To better understand what is endometriosis, it is necessary to present some basic notions of uterine anatomy and physiology.

The normal uterus is composed of 3 layers of tissue, the endometrium being the inner layer that undergoes major changes in each menstrual cycle (the small blood vessels formed at this level are actually the source of menstruation which is eliminated monthly through the vagina).

Endometriosis occurs when a structurally similar endometrial tissue appears localized in places other than normal. It can be found in the ovaries, peritoneum, intestine, bladder and even the lung or brain.

The dimensions of these formations differ and can vary from a few millimeters to a few centimeters. The classification of endometriosis is quite difficult to identify, for the identification of ectopic (abnormally located) lesions, being most often necessary for exploratory laparoscopy.

This consists in the introduction into the abdomen of a device equipped with fiber optics (laparoscope), which identifies endometriosis lesions, a relatively safe maneuver and does not cause major complications. The diagnosis of certainty of endometriosis consists of performing an exploratory laparoscopy that shows the ectopic formations, followed by the sampling of biospies, which will be analyzed by the specialist anatomopathologist.

There are several classifications of the disease, the most frequently used being the one that quantifies the severity of the disease according to several factors:

  • lesion characters (the newest ones are red, usually located at the level of the peritoneum, the leaf covering the abdominal organs; the later ones are darker, brown or black)
  • the presence of adhesions (scarring lesions that abnormally bind certain tissues or organs)
  • the presence or absence of ovarian cysts (these can be up to several centimeters in size and can cause serious complications if they rupture)
  • the appearance of complications (fixation of the abdominal or pelvic organs by scar tissue, obliteration, bleeding, infections, etc.). Thus, 4 stages can be formulated, the first being the easiest and 4 the worst.
  • The exact cause of the occurrence of endometriosis is unknown, but several hypotheses and theories have been discussed. One of them argues that endometriosis occurs secondary to a retrograde flow of menstruation (part of the central blood is retained in the uterus and migrates retrograde to the other surrounding tissues and organs).

    Because menstrual blood also contains endometrial cells, they can multiply, sow and localize on different organs, thus forming ectopic endometrial lesions. This theory is accepted by most gynecologists, but does not explain the etiology of endometriosis with cerebral or pulmonary localization.

    Other theories propose different mechanisms for the onset of endometriosis. One of them says that endometriotic lesions occur secondary to the transport of endometrial tissue by hematogenous or lymphatic route. Another theory involves deficiency of the immune system in the development of endometriosis, as well as of genetic factors.

    Symptoms

    Some women with endometriosis have no symptoms of the disease, others may have one or more of the following symptoms:

  • chronic pelvic pain, located in the lower abdominal floor (pelvis) or in the sacral lumbar region
  • dysmenorrhea (pain during menstruation). This is usually bilateral (may also appear unilaterally, depending on the location of the endometriotic lesions), occurs 24-48 hours before the actual menstruation and decreases in intensity immediately after it, but sometimes may persist throughout the menstruation
  • primary infertility, endometriosis being one of the most common causes of infertility in women
  • dyspareunia (pain during sexual contact)
  • urinary disorders during menstruation (frequent, painful urination), similar to those of low urinary infections (cystitis)
  • bloating, painful abdominal cramps, intestinal transit accelerated with diarrhea or diminished with constipation installed with menstruation
  • metrorrhagia (abnormal bleeding occurring during the menstrual cycle), occurs in approximately 15-20% of women with endometriosis; Menorrhagia (long-term care).
  • Diagnostic

    The symptoms mentioned above and especially the unexplained infertility, direct the patient towards a specialized medical consultation. Most often it starts with a simple gynecological examination (with valves) that can identify the typical lesions with localization in the cervix or a pathological serosanghinolent leak (brown).

    Abdominal ultrasound and endovaginal probe ultrasound can identify ovarian cystic lesions. Exploratory and diagnostic laparoscopy is the most commonly used method when certainty diagnosis is desired because it allows biopsies to be taken.

    It also quantifies the extent, age and severity of endometriotic lesions. This is done after performing general anesthesia or spinal anesthesia. Other methods used for the diagnosis and staging of endometriotic disease are computed tomography or nuclear magnetic resonance imaging.

    Complications

    Among the complications of endometriosis we mention: (anesthesia of the lower part of the body with the maintenance of consciousness). Through a small incision, it is inserted into the abdomen of carbon dioxide to create a workspace, followed by the laparoscope equipped with fiber optics to identify the endometriotic lesions at this level and also to take biopsies where appropriate.

  • rupture of ovarian cysts with the appearance of peritonitis (inflammation of the liver that clutches the abdominal organs)
  • endometriotic lesions located in the urinary or intestinal tract can cause complications at this level (intestinal occlusion, urinary obstruction, urinary infections, etc.).
  • damage to the organs at which the endometriotic lesions (erosions, bleeding) are located.
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