Endometriosis of the pelvic peritoneum
The spread of the endometrium of the uterus outside this organ can occur both in the reproductive system and in the intestine, in the bladder, in the peritoneum of the pelvis, in the lungs and even in the eyes. Endometrial cells in any part of the female body are subject to the cyclic action of female hormones and bleed during menstruation.
If there is no outlet of blood from damaged vessels, it accumulates, forming cysts, nodes, plaques and other formations. This disease is very common among women of reproductive age with gynecological problems. Among those patients who are treated for infertility and undergo a detailed examination (in particular, laparoscopy), up to 44% have a similar diagnosis.
Extragenital endometriosis, which includes lesions of the pelvic peritoneum, accounts for 6 to 8% of all recorded cases of the disease. Regardless of the place of localization, endometriosis is not a local, but a general disease that causes disturbances in the work of the endocrine and nervous systems in a woman.
Content:
- Etiology of the disease
- The clinical picture of peritoneal endometriosis
- Diagnostics of the peritoneal endometriosis
- Surgery
- Conservative treatment
- Disease prognosis
Etiology of the disease
The atypical spread of endometrial cells is based on their movement through the flow of blood and lymph to other organs and tissues.
This is facilitated by medical manipulations inside the uterus:
- Diagnostic curettage;
- Abortion;
- Cesarean section;
- Manual examination of her cavity after childbirth.
Among other factors in the development of the disease, experts call injuries to the inner surface of the abdominal cavity, combined with reduced immunity. It can be inflammation, mechanical damage, surgery. In addition, genetic predisposition plays an important role.
There is an assumption that endometrial cells during menstruation, for some reason, are not excreted through the cervical canal, but are thrown into the abdominal cavity through the fallopian tubes. Normally, this situation is stopped by immune cells (macrophages), but in case of problems with the endocrine and immune systems, this protection may not work. Peritoneal cells (mesothelial cells) begin to interact with endometrial cells, forming foci of the disease.
The clinical picture of peritoneal endometriosis
There are two forms of peritoneal endometriosis:
- Heterotopy is diagnosed exclusively in the peritoneum of the small pelvis;
- In addition to the peritoneum, endometriosis affects the uterus, ovaries, fallopian tubes, and intestines.
The severity of the disease depends on the following factors:
- The area of foci of peritoneal endometriosis (from extensive to minimal);
- The presence of adhesions, their severity (from single to complete obliteration);
- The depth of the lesion of the peritoneum (1-3 cm).
The minor form of the disease does not manifest itself for a long time, it proceeds latently.
With the spread of foci of the disease into the deeper layers of fiber before and after menstruation, the following symptoms appear:
- Exhausting pains in the lower abdomen of a pulling or aching character;
- Discomfort during sexual intercourse and physical activity;
- Dysfunction of the abdominal organs - problems with urination, defecation, bending of the uterus due to adhesions in the peritoneum;
- Lack of normal ovulation due to adhesions, and, as a result, infertility.
Diagnostics of the peritoneal endometriosis
Most often, abdominal endometriosis is detected during laparoscopy.
Morphological manifestations of peritoneal endometriosis:
- Whitish vesicles without pigment;
- Hemorrhagic vesicles - small cysts filled with thick tarry contents;
- Superficial and deep foci of the endometrium (heterotopia) of blue, purple, black;
- Knots, tubercles, spots painted in yellow-brown color.
Surgery
The only radical remedy to get rid of foci of endometriosis is laparoscopy.
This procedure has many positive properties:
- She is less traumatic;
- The woman does not lose the ability to bear children;
- During laparoscopy, the doctor has the opportunity to objectively assess the condition of the internal organs;
- The very next day, in the absence of complications, you can leave the hospital;
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The traces from the operation heal quickly, they are 3 small punctures in the anterior wall of the peritoneum.
During laparoscopy, the doctor grabs the endometriosis focus with a clamp and cuts it off with special scissors. The defects of the peritoneum remaining after this heal quickly. To prevent the disease from spreading further, the tissue excised during laparoscopy is removed through the operating channel in a special container.
In addition to surgery, it is possible to carry out cryodestruction, laser coagulation, excision of nodes with an electric knife, an argon coagulator, an ultrasonic scalpel.
Conservative treatment
In addition to removing foci of the disease, the goal of specialists involved in the treatment of endometriosis is:
- Prevention of relapse of the disease;
- Protection from complications, consequences of adhesive disease;
- Pain therapy;
- Treatment of post-hemorrhagic anemia;
- Relief of neuropsychiatric manifestations.
Hormone therapy lasts from 2 months to six months.
It includes the following groups of drugs:
- Estrogen-gestagens - Mikroginon, Diane-35, Ovidon, Rigevidon, Anovlar, side effect - increased risk of thrombosis;
- Progestins that effectively relieve pain - Norkolut, Depostat, Duphaston, Orgamethril, side effect - weight gain, swelling of the extremities, breast tension, breakthrough uterine bleeding;
- Agonists of gonadotropin-releasing hormone, causing temporary amenorrhea - Suprefect-depot, Zoladex, Decapeptyl-depot, side effect - hot flashes, similar to menopause;
- Androgens - Testosterone, Sustanon-250;
- Anabolic steroids - Retabolil, Methylandrostenediol;
- Antiestrogens - Tamoxifen, Toremifen.
These drugs require strict control of contraindications and side effects.
Other groups of drugs for symptomatic treatment:
- Immunomodulators - Levamisole, Cycloferon, Timogen;
- Antioxidants - ascorbic acid, vitamin E, pycnogenol;
- NSAIDs for the relief of pain and treatment of inflammatory processes - Brufen, Indomethacin;
- Antispasmodics - Analgin, No-shpa;
- Tranquilizers to eliminate neurological manifestations - seduxen, Elenium, Fenazepam, Rudotel, Tazepam;
- Iron preparations for the treatment of hemorrhagic anemia (Ferroplex, Fenuls).
With an accurate selection of drugs and following the doctor's recommendations, peritoneal endometriosis is effectively treated.
Disease prognosis
Relapses occur in 20% of women of reproductive age with a similar diagnosis. In premenopausal women, the prognosis is more favorable, because the production of estrogen by the ovaries gradually decreases. After radical surgery, peritoneal endometriosis does not recur, fertility is restored.
The author of the article: Lapikova Valentina Vladimirovna | Gynecologist, reproductologist
Education: Diploma in Obstetrics and Gynecology received at the Russian State Medical University of the Federal Agency for Healthcare and Social Development (2010). In 2013 completed postgraduate studies at N. N. N. I. Pirogova.
