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Endometriosis: Diagnosis

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Endometriosis: Diagnosis Laparoscopic Images VI. Diaphragmatic endometriosis * Abdominal view of liver and diaphragm liver diaphragm VI. Diaphragmatic endometriosis ... – PowerPoint PPT presentation

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Title: Endometriosis: Diagnosis


1
Endometriosis Diagnosis
  • Laparoscopic Images

2
Laparoscopic Images
3
Laparoscopic Images
4
Laparoscopic Images
5
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

6
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

7
I. Diffuse peritoneal endometriosis
Uterus
  • Uterus with adenomyosis uteri
  • Appearance of prominent vessels on fallopian
    tubes, bladder, peritoneum and parametrial area

8
I. Diffuse peritoneal endometriosis
View of pouch of Douglas. Filmy adhesions with
endometriotic lesions
9
I. Diffuse peritoneal endometriosis
  • Scar tissue from endometriotic lesions

10
I. Diffuse peritoneal endometriosis
  • Post surgery. Light areas are coagulated
    endometriotic lesions

11
I. Diffuse peritoneal endometriosis
  • Diagnosis
  • Endometriosis rASRM III (18 points) with
    obliteration of pouch of Douglas
  • Adenomyosis uteri

12
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

13
II. Endometrioma
uterus
endometrioma
Pelvic cavity large endometrioma and uterus with
fallopian tubes
14
II. Endometrioma
endometrioma
15
II. Endometrioma
endometrioma
fallopian tube
fimbriae
Right fallopian tube, fimbriae adherent to cyst
16
II. Endometrioma
uterus
right adnexal structures
Site after removal of the endometrioma
17
III. Obliteration of the pouch of Douglas
  • History
  • 42 yrs, G1 P1, presents in Sept 2009
  • Primary dysmenorrhea, menorrhagia days 1-3 (gt 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

18
III. Obliteration of the pouch of Douglas
uterus
Enlarged uterus with obliteration of the pouch of
Douglas
19
III. Obliteration of the pouch of Douglas
Conglomerate tumor
Conglomerate tumor (comprising uterus, ovary and
bowel with adhesions)
20
III. Obliteration of the pouch of Douglas
adenomyosis
Fixed uterus with prominent adenomyosis
21
III. Obliteration of the pouch of Douglas
postoperative mobilisation
Laparoscopic view after vaginal hysterectomy with
removal of right adnexal structures
22
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

23
IV. Bladder endometriosis
Cystoscopy with bladder endometriosis
24
IV. Bladder endometriosis
uterus
Pelvic area with bladder endometriosis, adhesions
of bladder and uterus
25
IV. Bladder endometriosis
bladder
Incision of the bladder
26
IV. Bladder endometriosis
bladder endometriosis
Removal of the lesion
27
IV. Bladder endometriosis
bladder
Resealed bladder
28
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

29
V. Rectovaginal endometriosis
uterus
bowel endometriosis
Deep infiltrating bowel endometriosis
30
V. Rectovaginal endometriosis
bowel endometriosis
Mobilisation of rectum, bowel endometriosis
31
V. Rectovaginal endometriosis
anastomosis
Creating an anastomosis after anterior rectum
resection
32
V. Rectovaginal endometriosis
anastomosis
Pelvic region after anterior rectum resection
33
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

34
VI. Diaphragmatic endometriosis
diaphragm
liver
Abdominal view of liver and diaphragm
35
VI. Diaphragmatic endometriosis
diaphragmatic endometriosis
Endometriotic lesions
36
VI. Diaphragmatic endometriosis
removal of peritoneum
After excision of lesions
37
VI. Diaphragmatic Endometriosis
Adenomyosis and peritoneal endometriosis
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