She came to our clinic with severe pain with every menstrual period, extensive adhesion involving the ovaries, the colon, and the omentum “fold of peritoneum”, chocolate cysts 6 cm and 10 cm with damaged ovarian reserves. This is Endometriosis!
Endometriosis refers to having the inner lining of the womb elsewhere in the abdomen or pelvis. It can affect 1 of every 8 women. There are 4 degrees of this condition. The 3rd and 4th degrees of it are considered the worst.
Unfortunately, Endometriosis can lead to catastrophic events, including chocolate cysts, damaged fallopian tubes and ovaries, decreased fertility, and severe adhesions and fibrosis of the pelvic region.
This is considered one of the most common causes of pelvic pain in women. This severe pain can drive the patients to analgesic addiction, skipping work and mental instability.
The ideal management of its advanced degrees is laparoscopy. During this intervention, all the cysts can be removed completely. And with some modern equipment, the adhesion can be dealt with.
Now, I can’t emphasize how important this is, removal of the entire chocolate cyst is mandatory. You can’t just pierce the cyst, aspirate its contents and that’s it. You have to take the whole thing out, including its walls. Otherwise, the cyst will form again after a while, and it would cost the patient another laparoscopy.
Our arch-enemy in this case is laparotomy. Surgical incision and opening of the tummy wall, in a patient with endometriosis, can lead to extensive adhesion.
My advice for everyone reading this is to avoid open conventional surgeries in this conditions. This surgery will make the laparoscopy later much more difficult to perform. Whatever the surgeons tell you about your condition, please don’t accept the laparotomy option.
