Long-term outcomes of catheter-directed sclerotherapy for ovarian endometrioma.

PURPOSE: Although favorable results have been reported on catheter-directed sclerotherapy (CDS) for ovarian endometrioma, a thorough evaluation of its long-term efficacy is lacking. This study evaluates the long-term efficacy and safety of CDS with 99% ethanol for treatment of ovarian endometrioma. METHODS: Between January 2020 and February 2022, data from 33 consecutive patients with symptomatic ovarian endometriomas who underwent CDS were retrospectively evaluated. All patients underwent pre-procedural and 6- and 12-month post-procedural ultrasonography. To assess the effect on ovarian reserve, serum anti-Müllerian hormone (AMH) levels were measured before and after the procedure. Procedure-related complications were also assessed. RESULTS: The mean volume of endometriomas decreased from 80.22 ± 66.43 to 0.73 ± 1.10 mL (P < 0.001), and the mean percentage of volume reduction was 98.99% ± 1.53%. No recurrences were observed during the follow-up period. In patients whose serum AMH levels were monitored for 1 year, no significant change in AMH level before and after CDS was observed (3.07 ± 1.81 vs. 2.72 ± 2.02 ng/mL, P = 0.190). One patient complained of moderate abdominal pain after CDS, which was conservatively managed. CONCLUSION: CDS remained safe and effective in treating ovarian endometrioma at the 1-year follow-up. Ovarian function after CDS was well preserved. CLINICAL SIGNIFICANCE: CDS is a safe and effective treatment option for patients with ovarian endometrioma without compromising ovarian function.

Factors affecting the technical outcome of catheter-directed sclerotherapy for ovarian endometriomas.

PURPOSE: To identify factors related to technical outcomes of catheter-directed sclerotherapy (CDS) and suggest selection criteria for CDS in patients with ovarian endometrioma. METHOD: This retrospective study included patients with endometriomas treated with CDS between November 2015 and June 2023. The characteristics of the endometriomas, including diameter, morphology (unilocular or multilocular), and T2 signal intensity were evaluated using pre-procedure magnetic resonance imaging. Moreover, the size of the catheter (7- or 8.5-French) and route of access (transabdominal vs. transvaginal) was also analyzed. Multivariate logistic regression analyses were used to identify factors associated with the technical outcomes of CDS. RESULTS: Technical success was defined as successful completion of the following: 1) insertion of a 7- or 8.5-French catheter into the endometrioma, 2) full aspiration of the internal content, and 3) completion of sclerotherapy without ethanol leakage. Of the 323 women (mean age = 32.2 ± 6.0 years) with 401 endometriomas included in our study, technical success was achieved in 377 endometriomas (94.0 %). No major complications were observed. In the multivariate analysis, a diameter < 3 cm (odds ratio, 25.641; p < 0.001), T2 dark signal intensity (odds ratio, 7.462; p = 0.001), and transvaginal access (odds ratio, 4.016; p = 0.004) were associated with technical failure. CONCLUSIONS: Small endometrioma size (<3cm), T2 dark signal intensity, and transvaginal access were identified as significant risk factors for technical failure during catheter-directed sclerotherapy.

Pregnancy-related decidualization in post-cesarean section scar endometriosis: A case report.

INTRODUCTION AND IMPORTANCE: Post-cesarean section decidualized endometriosis is a rare phenomenon where ectopic endometrial cells undergo changes, such as atypia, under the influence of high progesterone levels at the site of cesarean section. This phenomenon can create a diagnostic challenge as it mimics the characteristics of malignancy to some extent. CASE PRESENTATION: We report a case of a 38-year-old G6P2 woman who was electively referred to the OB ward for a cesarean section. Ultrasonography revealed a 38 × 29 × 26 mm lobulated solid lesion within the rectus abdominis muscle located in the midline of the suprapubic abdominal wall in the 16th week of gestation. Histological evaluation of the specimen showed endometrial glands surrounded by severely decidualized stroma. CLINICAL DISCUSSION: To our knowledge, we present the ninth case report of decidualized endometriosis located on a post-cesarean section scar. Our case was in the younger demographics and histopathologically her resected tissue contained glandular structures. There was no past medical history of endometriosis. Extra pelvic localization of the tissue could have led us to a diagnostic pitfall. CONCLUSION: Understanding this phenomenon's pathologic and clinical characteristics can help pathologists and surgeons to rule out malignancy and avoid conspicuous diagnostic errors.

Long Term Postoperative Recurrence Rates and Fertility Outcomes after Endometrioma CO2-Laser Vaporization: a 5 years follow-up experience.

STUDY OBJECTIVE: Although cystectomy remains the gold standard for the surgical treatments of endometriomas, concerns about the negative effect on ovarian reserve are rising. Laser-CO2 vaporization of endometriomas has showed encouraging data on ovarian reserve preservation, postoperative pregnancy rates and recurrency. The aim of this study was to assess postoperative recurrence rate and pregnancy rate in patients with endometriomas managed by CO2 fiber laser vaporization after at least 5 years following surgery. DESIGN: Retrospective study. SETTING: Italian tertiary center from October 2023 to February 2024. PATIENTS: We included women aged >18 years who underwent laparoscopic CO2 fiber laser vaporization for endometriomas. Age ≥ 40 years, previous ovarian surgery, previous salpingectomy or hysterectomy, negative histologic finding for endometriosis or any findings of malignancy at histology were exclusion criteria. INTERVENTION: Ovarian endometriomas were vaporized through laparoscopic CO2 fiber laser. After surgery, patients were included in a surveillance program with periodic clinical follow-up. MEASUREMENTS AND MAIN RESULTS: Seventy-eight patients were included. The mean age was 33.2±4.6 years, the basal AMH was 2.7 ± 1.9 ng/mL and the median diameter of the endometriomas was 4(3-5)cm. The median duration of follow-up was 72.5 months(67-84.5). After surgery, 65.5%(n=36) of women with reproductive desire achieved a pregnancy, 55.6% spontaneously and 44.4% through Assisted Reproduction Techniques, with a mean time to pregnancy of 17.7±18.1 months. A Kaplan-Meier curve for the 7 patients who experienced an ipsilateral recurrence showed that the median time to recurrence was 26 months and the estimated rate of disease-free patients was 91.03% at 100 months (95% CI 82.10%-95.62%). CONCLUSION: CO2 fiber laser vaporization is an effective and safe surgical treatment of ovarian endometriomas, combining the advantage of being an ovarian tissue-sparing technique with long-term post-operative recurrence rate comparable with that described in literature for the cystectomy.

Endometrial E-cadherin and N-cadherin Expression during the Mid-Secretory Phase of Women with Ovarian Endometrioma or Uterine Fibroids.

BACKGROUND: Endometriosis and uterine fibroids are benign conditions frequently linked to subfertility/infertility. Recent research has highlighted the importance of epithelial-mesenchymal transition between embryonic and endometrial cells in the context of embryo implantation. Additionally, the adverse endometrial environment during implantation has been proposed as a mechanism contributing to infertility in endometriosis. Nevertheless, the role of cadherin molecule alterations in relation to endometrial receptivity and embryo invasion remains a subject of controversy. METHODS: We investigated the expression patterns of E-cadherin and N-cadherin in the endometria of women with ovarian endometrioma or uterine fibroids and assessed whether they differed from those of healthy women. We enrolled 17 women with ovarian endometrioma, 16 with uterine fibroids, and 6 healthy women. Endometrial tissues were obtained at the mid-secretory phase on days 19-24 of the menstrual cycle. The E-cadherin and N-cadherin mRNA and protein expression levels were measured using quantitative reverse transcriptase polymerase chain reaction and Western blot analysis, respectively. RESULTS: The E-cadherin and N-cadherin mRNA expression levels were higher and lower, respectively, in the endometrium of women with ovarian endometrioma than in those of the controls. In the endometrium of women with uterine fibroids, similar patterns with higher E-cadherin and lower N-cadherin levels were observed compared with that of the controls. Protein expression showed similar patterns. CONCLUSIONS: Our findings revealed higher E-cadherin expression and lower N-cadherin expression in the endometria of women with infertility-related diseases than in those of healthy women in the mid-secretory phase. This suggests a resistance to endometrial receptivity, potentially reflecting mesenchymal-epithelial transition properties.

What's Now and What's Next for Surgical Endometriosis Management in the Infertile Patient? An Evidence-Based Review for the General OB/GYN.

Endometriosis is a significant contributor to female infertility, and its complex nature and varied phenotypes lead to questions regarding the value of surgical management. In this manuscript, we summarize current evidence and recommendations regarding surgical treatment for infertility in peritoneal disease, endometriomas, adenomyosis, and deep endometriosis, and highlight recent evidence regarding perinatal outcomes in women with endometriosis. Our purpose is to provide a concise "user's guide" for decisions regarding the surgical management of endometriosis in patients with infertility and generate awareness of recent perinatal outcome data.

Morphological changes of endometriomas during pregnancy and after delivery detected using ultrasound.

OBJECTIVE: To assess changes in morphology and size of endometriomas during pregnancy and after delivery. DESIGN: This was a prospective observational cohort study performed during 2013-2024 at a tertiary care center (Ultrasound Unit, Department of Obstetrics and Gynecology, Skane University Hospital, Malmo, Sweden). Women were offered repeated ultrasound examinations every month during pregnancy and thereafter at 3 and 12 months after delivery. Ultrasound examinations were performed either transvaginally or transabdominally depending on the gestational week and assessability of the ovaries. SETTING: University hospital, tertiary care center. PATIENT(S): Pregnant women with an ovarian cyst suggestive of endometrioma based on subjective assessment were eligible and those with the pregnancy that continued beyond gestational age of 22 weeks were included. In total, 57 women were included. INTERVENTION(S): Pregnancy. MAIN OUTCOME MEASURE(S): Changes in morphology (cyst type, cyst content, and signs of decidualization) and size of the endometrioma and the largest solid component were assessed during follow-up ultrasound examinations. RESULT(S): During pregnancy, endometriomas changed in morphology in 42/57 women (74%; 95% confidence interval [CI], 60-84) and decreased in size in 42/57 women (74%; 95% CI, 60-84). Decidualization of endometrioma was observed in 33/57 women (58%; 95% CI, 44-71) and was detected first time at gestational age of 17 weeks (median, interquartile range, 15-22; range, 6-29). The size of endometriomas decreased although the size of solid components increased from gestational age of 22+0 weeks. Signs of decidualization disappeared after delivery. CONCLUSION(S): Three out of four endometriomas undergo morphological changes during pregnancy. Decidualized endometrioma may mimic borderline malignancy, however, changes regress after delivery. Knowing the natural behavior of endometriomas during pregnancy is crucial to reducing the risk of misclassification of endometriomas as malignant masses. Follow-up ultrasound examination after delivery helps to reassure the benign nature of the cyst.

Abdominal Wall Endometriosis: A Case Report and Literature Review of Pfannenstiel Incision Endometrioma.

We depict a unique case of a 39-year-old woman who presented to the emergency department with complaints of right upper quadrant pain. Work-up and a computed tomography (CT) scan revealed acute cholecystitis and the patient underwent laparoscopic cholecystectomy without complication. At this time, an incidental mass was discovered in the subcutaneous fat adjacent to the abdominal wall. The patient returned six months later with progressive, cyclic abdominal pain since her last hospital admission. Initial admission lab work was within normal limits and a urine pregnancy test was negative. Physical exam revealed tenderness around her previous cesarean section scar. Repeat CT revealed an enlarging, spiculated mass adherent to the abdominal wall. After imaging confirmation, the patient underwent complete open surgical excision for the removal of the mass. Post-surgical biopsy confirmed endometrial gland and stroma consistent with abdominal wall endometrioma. The patient was discharged with adjuvant therapy and recommended follow-up with the surgeon and her obstetrician-gynecologist. The radiological diagnosis, guidelines, and decision-making for initiating interventional treatment are discussed in this report. Our purpose in documenting this case is to present a rare diagnosis of an atypical location for an endometrioma on the abdominal wall, in a patient with prior cesarean delivery. Although this patient was treated with open excision, different interventional radiology treatments from radiofrequency ablation and focused ultrasound were discussed. In doing so, we hope to contribute to the systematic literature review on surgical excision as a treatment option for Pfannenstiel incision endometrioma.

Peritonitis caused by Mycoplasma hominis after laparoscopic total hysterectomy: A case report.

Infections after obstetric and gynecologic surgery are commonly caused by enterobacteria, commensal vaginal bacteria, or indigenous skin bacteria (primarily Staphylococcus aureus and Streptococcus). Mycoplasma hominis (M. hominis) rarely causes postoperative infection in the field of obstetrics and gynecology and its treatment is generally delayed. This report describes a case report of peritonitis caused by M. hominis after laparoscopic total hysterectomy. A 44-year-old patient (gravida 1, para 1) presented with heavy menstrual bleeding and severe anemia. She was diagnosed as having multiple uterine fibroids and bilateral endometriomas and underwent laparoscopic surgery. She subsequently developed postoperative peritonitis due to M. hominis. This microorganism was identified in the postoperative cultures of the vaginal discharge and the transvaginal drainage fluid by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. The patient was treated successfully with the appropriate antimicrobial agents. It is important to consider M. hominis infection when gynecological postoperative infection persists despite treatment with beta-lactam antibiotics, and no causative organisms are identified by Gram staining.

An uncommon case of an infected ovarian endometrioma.

INTRODUCTION AND IMPORTANCE: Ovarian endometriosis is common, most often associated with other endometriotic lesions of the pelvis. Among the classic complications of endometriosis, secondary infection is described but rare. We report a very interesting case of an endometrioma cyst mimicking a tubo ovarian abscess. We describe our diagnosis and surgical management by laparoscopic approach. CASE PRESENTATION: A case of a 32-year-old patient, with a history of surgery for ovarian and deep peritoneal endometriosis, who consulted urgently for pelvic pain syndrome in a febrile context. Emergency laparoscopic surgery showed secondary infection of the endometriosic cyst with the presence of pus. A right adnexectomy was performed. The postoperative follow-up was simple. DISCUSSION: Secondary infection of endometriomas is a classically described but rare complication. Severe endometriosis would be a risk factor for developing a tubo-ovarian abscess with an incidence of 2.3 % in patients with endometrioma. Laparoscopic endometrioma surgery has demonstrated its superiority beyond question, numerous trials have confirmed these data. The benefit is established in terms of pain, infectious risk, scarring, wall complications, adhesion risk, length of hospitalization, return to normal activity, thromboembolic risk and cost. CONCLUSION: Infection of an endometriosic cyst is an exceptional complication. It is necessary to emphasize the particularities of this surgery, namely careful dissection to avoid secondary lesions, particularly digestive.

Laparoscopic bilateral salpingo-oophorectomy for recurrent ovarian endometriotic cysts in a woman taking adjuvant tamoxifen for breast cancer: A case report.

The case report describes the management of endometriotic cysts in a woman taking adjuvant tamoxifen. A diagnosis of endometriosis was made at the age of 38, and the condition was initially managed with a low-dose estrogen-progestogen combination; the patient then switched to dienogest at the age of 45. Following a diagnosis of breast cancer at the age of 46, dienogest was stopped and adjuvant tamoxifen treatment started. After 4 months the patient was diagnosed with bilateral ovarian cysts and underwent laparoscopic bilateral salpingo-oophorectomy. Endometriosis was diagnosed in both ovaries on histopathological examination. This case report describes progression of endometriosis in a tamoxifen user.

Recurrence after surgery for endometrioma: a systematic review and meta-analyses.

IMPORTANCE: Endometriosis is an inflammatory disease, with different forms of expression and a variety of complaints. An endometrioma, an ovarian cyst with endometrium-like lining, is one of the most common expressions of abdominal endometriosis. These endometriomas can, in addition to medical treatment, be treated surgically. After surgery, hormonal therapy is still frequently used for the treatment of endometriosis in general and prevention of recurrence of endometriomas specifically. However, not all women want or can receive postoperative hormonal treatment. It is important for this group to determine the risk of anatomical recurrence of ovarian endometrioma after surgery for an endometrioma. OBJECTIVE: To determine the recurrence rate for surgically treated endometrioma without postoperative hormonal treatment. DATA SOURCES: We performed a systematic literature review and meta-analyses, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. MEDLINE, Embase, and the Cochrane library were searched until May 2023. The literature search was limited to women with endometrioma who received surgical treatment without postoperative hormonal treatment. STUDY SELECTION AND SYNTHESIS: A distinction was made in study design including randomized controlled trials (RCTs) and cohort and retrospective studies. For assessment of risk of bias, the Cochrane Handbook for Systematic Reviews of Interventions and Risk of Bias in Non-randomized Studies - of Interventions assessment tool were used. MAIN OUTCOMES: The outcome measure included in this review was endometrioma recurrence. RESULTS: We screened 5,367 articles, of which 97 were systematically reviewed and 55 were included in this systematic review. Twelve of these were RCTs, 11 were prospective cohort studies, and 32 were retrospective studies. Nine RCTs had a low risk of bias. For non-RCTs, only 3 studies had a low risk of bias. Data of 23 studies were pooled in meta-analyses, performed for follow-up periods of 3, 6, 12, and 24 months. These studies showed recurrence rates of 4%, 14%, 17%, and 27%, respectively. CONCLUSION AND RELEVANCE: In the meta-analysis, at 24 months after surgery, the endometrioma recurrence rate showed a weighted mean of up to 27%. In this study, we aimed to determine the recurrence rate of endometrioma after surgical treatment in women without postoperative hormonal treatment use. The recurrence rates were up to 27%.

Ethanol sclerotherapy of endometriomas prior to IVF/ICSI improves progressive pregnancy and live birth rate.

RESEARCH QUESTION: What is the impact of ethanol sclerotherapy of endometriomas prior to IVF/ICSI on pregnancy rates? DESIGN: We reviewed women with endometrioma(s) larger than 25 mm having IVF/ICSI cycles. All patients with a history of ovarian cystectomy were excluded. Two groups were compared: patients who had transvaginal ethanol sclerotherapy of their endometrioma(s) before ovarian stimulation and patients whose endometrioma(s) were left in situ (untreated) at the time of IVF/ICSI (control group). Analyses were adjusted for confounding factors by inverse probability of treatment weighting. The primary endpoint was progressive pregnancy rates per IVF/ICSI cycle including fresh and frozen embryo transfers. Secondary endpoints were live birth rates, the number of mature oocytes retrieved, pregnancy loss. Endometriomas recurrence rates after sclerotherapy and procedural complications were also analyzed. RESULTS: A total of 96 cycles (67 patients) were included: 46 cycles (34 patients) in the ethanol sclerotherapy group and 50 cycles (33 patients) in the control group. After propensity score weighting, the pregnancy and live-birth rates were significantly higher in the ethanol sclerotherapy group compared to the control group (weighted OR, 2.9 ; 95 CI, 1.4 - 6.6 and weighted OR 2.4 ; 95 CI, 1.1 - 5.4 respectively), with a lower rate of pregnancy loss (weighted OR 0.3 ; 95 CI, 0.1 - 0.9). Ovarian response was similar in the two groups. The recurrence rate of endometrioma at 6 months after sclerotherapy was 20 %. CONCLUSION: Sclerotherapy of endometrioma before ovarian stimulation may increase pregnancy rate, with a low rate of recurrence and a minimal risk of complication.

Primary Extrapelvic Umbilical Endometriosis Presenting With Cyclical Umbilical Bleeding: A Case Report.

Primary extrapelvic endometriosis is the presence of endometrial tissue in sites outside the uterine cavity in an individual who has had no prior abdominal surgeries. Various theories have been postulated to describe the etiology of endometriosis. Our case study involves a multiparous patient in her late 40s with no prior abdominal surgeries who presented with bleeding from her umbilicus associated with swelling and pain corresponding to her menstrual cycle. A computed tomography scan of the abdomen detected a homogenous granuloma-like umbilical soft tissue mass. The umbilical nodule and the umbilicus were excised, and the specimen was sent for histopathological examination that validated the diagnosis of an umbilical endometrioma by revealing endometrial glands with stroma involving the dermis. Postoperatively, the patient was symptomatically better and was discharged. Primary umbilical endometriosis can mimic conditions like omphalitis, umbilical granuloma, and umbilical hernia; hence, it is important to understand how to differentiate this case from other diagnoses. This case contextualizes that the likelihood of primary umbilical endometriosis in such unusual presentations must always be considered.

Potential damage to ovarian reserve from laparoscopic electrocoagulation in endometriomas and benign ovarian cysts: a systematic review and meta-analysis.

PURPOSE: Laparoscopic cystectomy for ovarian endometriomas and benign ovarian cysts is often conducted through hemostatic methods, with bipolar electrocoagulation as a common approach. This study evaluated the impact of electrocoagulation, primarily through bipolar energy, versus nonthermal hemostatic methods on ovarian reserve in patients undergoing laparoscopic cystectomy for ovarian endometriomas and benign ovarian cysts. METHODS: A systematic review with meta-analysis was conducted by searching the Cochrane Library, PubMed, EMBASE, and Web of Science databases. Randomized controlled trials (RCTs) comparing the impact of nonthermal hemostatic methods and electrocoagulation on the ovarian reserve during laparoscopic cystectomy were included. The Cochrane Risk of Bias Tool for Randomized Controlled Trials (ROB 2.0) was utilized to assess the quality of the included studies. The meta-analysis included 13 RCTs involving 1043 patients. Postoperative serum anti-Müllerian hormone (AMH) levels and antral follicle counts (AFCs) were analyzed using Review Manager ver. 5.4. RESULTS: Compared with the bipolar group, patients with endometriomas in the nonthermal hemostatic group exhibited significantly higher postoperative AMH levels at 1, 3, 6, and 12 months. Conversely, no significant differences in AMH levels were observed in patients with benign ovarian cysts. Similarly, AFCs showed no significant differences, except for lower postoperative AFCs in patients with endometrioma in the electrocoagulation group. CONCLUSION: Nonthermal hemostatic methods are associated with more effective preservation of the ovarian reserve compared with bipolar electrocoagulation in laparoscopic cystectomy for ovarian endometriomas. However, no significant impact of bipolar electrocoagulation on the ovarian reserve was observed in patients with benign ovarian cysts. TRIAL REGISTRATION: Registered in PROSPERO on April 10, 2023; ID # CRD42023413158.

A new look at the theoretical causes of endometriosis: Narrative review.

Endometriosis is a major health concern in women who have it. Unfortunately, there is no definitive cure except panhysterectomy with its sequelae including induction of premature menopause due to loss of ovaries. Therefore, revealing the causes of this puzzling disease is necessary to avoid contracting it, and to spare women the health disorders resulting from it and the difficulties of treating it. We aimed to study endometriosis with a focus on its theoretical causes. Its classification reports and theories of pathogenesis were identified and studied from available database searches. The causes of endometriosis remain mysterious. Many theories have been proposed to explain the etiology, but retrograde menstruation (RM) remains the closest in this regard. Although this theory is the most accepted in the pathogenesis of endometriosis, its causes are still a matter of debate, especially in women who do not suffer from obstructions to menstrual outflows, such as cases of congenital cervical stenosis and imperforate hymen. It is suggested in some studies that there may be a relationship between women who engage in sexual activity during menstruation and the development of endometriosis. It is concluded that endometriosis is a painful and debilitating disease. Identifying its causes is essential to control the disease and avoid any burdens on health. RM is the main theory for its pathogenesis but its causes are still uncertain. Sexual activity during menstruation may be a possible cause of RM but needs more evidence. Future studies are recommended to reveal all aspects of the pathogenesis of endometriosis.

Epidemiologia, clínica y evolución en pacientes con endometriosis / Epidemiology, clinic and evolution in patients with endometriosis

Objetivo: Estudiar la relación que existe entre algunos factores predisponente a desarrollar endometriosis y síntomas más frecuentes que manifiestan las pacientes. Métodos: Estudio observacional longitudinal, retrospectivo y descriptivo, mediante la revisión de 455 historias tomadas 560 pacientes que acudieron a la consulta de endometriosis y realizando diagnóstico definitivo en el Hospital Universitario "Dr. Ángel Larralde" y consulta privada, en Venezuela, estado Carabobo, en el periodo de enero 2006 a mayo 2023. Resultados: El diagnóstico se realizó en un 47,1 % de las pacientes con edades entre 26 a 35 años. La menarquia se presentó entre los 8 y los 12 años (el 69 %). El 63 % no tenía embarazos. La dismenorrea primaria fue más frecuente en el 63,07 %. El dolor pélvico y dispareunia en el 48 %, los síntomas digestivos en el 21 %. La localización más frecuente fue en ovario (78,7 %). Conclusión: La endometriosis, enfermedad inflamatoria benigna, estrógeno dependiente, se caracteriza por presencia de glándulas y estroma endometrial ectópico, usualmente acompañados de fibrosis. Se manifiesta en el periodo reproductivo, su principal síntoma es el dolor. Se localiza con mayor frecuencia en la pelvis y de esta en los ovarios, en intestino, vejiga, hígado, pulmones, cerebro, pared abdominal y periné. No hay tratamiento para su cura, pero si para los síntomas y retardar su progreso. Su diagnóstico por su desarrollo multifactorial y manifestaciones clínicas en muchas oportunidades se realiza en forma tardía(AU)

Objective: To study the relationship that exists between some predisposing factors to develop endometriosis and the most frequent symptoms manifested by patients. Methods: Longitudinal, retrospective and descriptive observational study, through the review of 455 records taken from 560 patients who attended the endometriosis consultation and made a definitive diagnosis at the "Dr. Ángel Larralde" and private consultation, in Venezuela, Carabobo state, in the period from January 2006 to May 2023. Results: The diagnosis was made in 47.1% of the patients aged between 26 and 35 years. Menarche occurred between 8 and 12 years of age (69%). 63% did not have pregnancies. Primary dysmenorrhea was more frequent in 63.07%. Pelvic pain and dyspareunia in 48%, digestive symptoms in 21%. The most frequent location was in the ovary (78.7%). Conclusion: Endometriosis, a benign, estrogen-dependent inflammatory disease, is characterized by the presence of ectopic endometrial glands and stroma, usually accompanied by fibrosis. It manifests itself in the reproductive period, its main symptom is pain. It is located most frequently in the pelvis and from this in the ovaries, intestine, bladder, liver, lungs, brain, abdominal wall and perineum. There is no treatment to cure it, but there is treatment for the symptoms and slowing its progress. Its diagnosis due to its multifactorial development and clinical manifestations is often made late(AU)

Rupture Endometriomas Presenting as Acute Abdomen Infection in Hasty and Limited Resources Setting: A Pitfall Not to Miss - A Case Report.

Introduction: Abdominal pain is a diagnostic problem that requires immediate care and treatment for surgeons and gynecologists. The causes of abdominal pain in women of childbearing age range from benign and temporary to potentially life threatening. Rare etiologies such as spontaneous ruptured endometrioma are often not included in the radar of diagnosis due to their rarity and non-specific signs and symptoms in the patient. This case report aimed to show a resemblance between the clinical symptoms of acute abdomen in diffuse peritonitis due to hollow viscus perforation and spontaneous ruptured endometrioma. Case Description: A 42-year-old woman presented to our hospital with abdominal pain. She had a history of fever for two weeks. She came from a tropical rural area where typhoid fever is common. She was advised to undergo emergency laparotomy because of the suspicion of diffuse peritonitis due to a hollow viscus perforation due to typhoid infection. Because of acute abdominal pain, a vertical incision was made to explore her abdominal cavity, and chocolate-like fluid and ovarian cysts were found during surgery. The diagnosis was changed to diffuse peritonitis due to spontaneous rupture of the endometrioma bilaterally. Conclusion: This case suggests that the exact diagnosis and cause of abdominal pain varies. As the current gold standard for endometrioma is laparoscopy, surgeons must prepare a collaborative approach to the cause of the disease.

Abdominal pain is common and often requires prompt medical care. In women, it can have various causes, including rare ones, such as spontaneous ruptured endometrioma, which can be difficult to diagnose owing to its rarity and vague symptoms. We describe the case of a 42-year-old woman with abdominal pain and fever, initially suspected to have diffuse peritonitis due to typhoid infection. However, surgery revealed a ruptured endometrioma, highlighting the challenge of accurately diagnosing such conditions. This case emphasizes the need to consider the diverse diagnoses of abdominal pain and the importance of collaborative approaches among medical professionals to ensure accurate diagnosis and treatment.

The effects of oral nutritional supplements on endometriosis-related pain: A narrative review of clinical studies.

Endometriosis is a condition that can cause significant pain and discomfort for women, and the clinical and surgical treatments available have variable efficacy and can have adverse effects. These drawbacks often lead to poor adherence and therapeutic failure. Consequently, there has been increasing interest in the use of nutritional supplements as an adjuvant therapy for endometriosis. To facilitate clinical decision-making in managing women with endometriosis, a narrative review of clinical studies was conducted to investigate the effects of oral nutritional supplements on endometriosis-related pain. A literature search of the English-language PubMed/MEDLINE database was performed using appropriate keywords to identify clinical studies involving oral nutritional supplements and reporting on endometriosis-related pain. This narrative review included 20 studies published between 2013 and 2023, comprising 12 randomized controlled trials, six non-comparative trials, and two observational studies. The studies investigated the effects of various nutritional supplements on endometriosis-related pain, including vitamins, fatty acids, probiotics, medicinal plants, and bioactive compounds. A significant decrease in endometriosis-related pain was found in three out of five studies on vitamins, four out of six studies on fatty acids, one study on probiotics, two studies on medicinal plants, and five out of six studies on bioactive compounds. These nutritional supplements exhibited diverse biological activities, such as anti-inflammatory, antioxidant, antiproliferative, and antiangiogenic effects, all of which are relevant for managing endometriosis. These findings suggest that oral nutritional supplements could be included as part of a multidisciplinary treatment for endometriosis to decrease pain and enhance overall medical treatment.

A Case Report of Comprehensive Diagnostic Approach on a Complex Left Adnexal Mass in a Young Female: Endometrioma or Complicated Ovarian Serous Cystadenofibroma.

This case report presents a young female who was clinically, radiologically, and intraoperatively misdiagnosed as an ovarian endometrioma and was only diagnosed by histopathological biopsy as complicated serous cystadenofibroma, a rare benign tumor composed of both glandular and fibrous tissue. The diagnosis of adenofibroma typically involves a combination of imaging studies, such as ultrasound or magnetic resonance imaging (MRI) scan, and a histopathological biopsy to confirm the presence of the tumor. This case underscores the significance of utilizing various diagnostic methods and histopathological biopsies to diagnose and treat complex adnexal masses in females accurately.