| Contents:
HISTORY
Endometriosis was first described by
Daniel Shroen in 1690 in Disputatio Inauguralis Medica de Ulceribus Ulceri, in
which he described sores throughout the "stomach," bladder,
intestines, and broad ligament which had a tendency to form adhesions that
linked visceral areas together. Later, in 1769, Arthur Duff described the
intense pain and suffering of these women, with morbid symptoms that manifestly
change the disposition of the entire body.
 WHAT IS ENDOMETRIOSIS?
The normal human uterus is made up of
a muscular layer (the myometrium) and a thin layer that lines the inner uterine
cavity, called the endometrium. These endometrial glands and stroma,
should they be present in extrauterine locations (outside the uterine cavity),
are characteristic of endometriosis. The locations that this endometrial
tissue can be found range from the ovaries (the most common location), the
ligamentous structures that surround the uterus, the pelvic peritoneum (lining
of the pelvic wall), and old surgical scars. Although much less
common, endometriosis has been found in the gastrointestinal tract, the lungs,
the nervous systems, and even the musculoskeletal system. These
extrauterine foci of endometrial tissue are under the same hormone control as
the endometrium lining the uterine cavity. Thus, each month when the
normal endometrium engorges with blood, and then sheds this dead tissue, the
same phenomenon is occurring with these endometriotic lesions on ovaries,
bowels, or pelvic wall. This extrauterine blood caused inflammation and
swelling at the endometriotic sites, leading to pain and discomfort.
INCIDENCE AND PREVALENCE
- 10% of women in the reproductive age
group have endometriosis
- 30-50% of infertile women have endometriosis
- Occurs primarily in women in their 20's and
30's
- Once thought that middle-class, white patients
who are high achievers and perfectionists were at higher risk
 WHAT CAUSES ENDOMETRIOSIS?
No one knows for certain what
causes these extrauterine implants of endometrial tissue, however, there are
many theories as to why women get endometriosis. The three predominate
theories about why women contract endometriosis are Sampson's, Halban's and
Meyer's Theories.
- The implantation theory (Sampson's) is based on
the principle of retrograde menstruation. Laparoscopy has demonstrated
that this is a universal phenomenon in women with patent fallopian
tubes. During a normal menstrual period, some of the blood is
"refluxed" into the fallopian tubes, and out into the pelvic
cavity, where it can attach to the ovaries, bowel, pelvic wall, and even old
laparotomy scars.
- The lymphatic/vascular dissemination (Halban's)
theory holds that endometriosis is caused by pieces of the endometrium
getting into the local blood and lymphatic channels and being transported to
distant sites. This theory would explain the presence of endometriosis
in the pleural cavity, veins, kidneys, bone, muscle, skin, and lymphatics.
- The coelomic metaplasia (Meyer's) theory is
based on the idea that during embryological development, there are cells,
called multipotential cells, that line the whole pelvic cavity. As we
mature, these cells differentiate into specific organs or tissue.
However, it is postulated that these differentiated cells can
"dedifferentiate", or undo themselves, and become a new type of
tissue or organ. In other words, the cells that cover the ovaries, for
example, may "dedifferentiate" and become endometrial cells.
Thus, this new endometrial tissue on the ovary would undergo cyclic changes
with menstruation, much like its normal counterpart in the uterus.
 SYMPTOMS
 DIAGNOSIS
Definitive diagnosis can only be obtained through
surgery. A procedure called diagnostic laparoscopy can be performed and
biopsies of the suspected endometriotic lesions can be taken. However, the
diagnosis can often be made just by direct visualization of these lesions during
laparoscopy. All of the following are suggestive of endometriosis at the
time of laparoscopy:
- Vascular hemorrhagic areas,
"raspberry" in appearance.
- "Powder burn" lesions
- Dense adhesions with obscured pelvic anatomy
- Endometriomas, or "chocolate cysts"
on ovaries.
|
