20 00:00:00-05-2022
Updated on
20 00:00:00-05-2022
Deep pelvic endometriosis is a severe form of endometriosis where lesions deeply infiltrate the retroperitoneal space or the walls of pelvic organs, such as the vagina, rectum, and uterosacral ligaments. This condition can significantly impact the digestive system when it infiltrates the digestive muscularis or the urological system during bladder or ureteral muscularis infiltration. Characterized by deeply penetrating lesions, it often leads to more severe symptoms and complications compared to superficial endometriosis. Understanding the nuances of this condition is crucial for effective diagnosis and management.
A clinical interview and a gynecological examination make it possible to suspect the disease. When a gynecological examination is performed, an inspection is carried out and is followed by palpation. The practitioner performs a vaginal examination. This allows him to locate deep subperitoneal lesions and endometriotic cysts. This examination should be performed during menstruation for a more effective diagnosis. It also makes it possible to detect abnormalities, provided that it is carried out correctly.
Some professionals perform a vaginal examination that is too superficial and do not explore the area known as the Douglas cul-de-sac, the evaluation of which is possible by palpation of the posterior vaginal cul-de-sac. From this examination, painful nodules, uterine retroversion, i.e. malposition of the uterus, can be identified, or a larger and more painful ovary can be noticed.
It is also possible that a rectal examination is performed to diagnose deep pelvic endometriosis. It is carried out in particular in the event of suspected involvement of the posterior wall or when the patient complains of pain during defecation.
The performance of medical imaging examinations also makes it possible to diagnose deep pelvic endometriosis. For example, a pelvic or endovaginal ultrasound can locate endometriosis cysts outside the uterus. In addition, this examination guarantees exploration of the space located in front of the uterus and the retro cervical area.
The practice of hysterosalpingography is conceivable for diagnosing deep pelvic endometriosis. This is an X-ray of the uterus and fallopian tubes after injection of a contrast product. It is carried out in order to look for possible indirect signs of adenomyosis or to assess problems with the permeability of the fallopian tubes of the uterus.
For the diagnosis of the pathology, an endorectal ultrasound can be performed. This is done using a thin probe that is inserted into the rectum. From this examination, the exploration of deep endometriosis lesions is carried out and may concern the rectum, up to 25 cm above the anus.
Also note that MRI is a very reliable and precise examination for detecting deep pelvic endometriosis. It is an excellent technique for making a precise mapping of deep subperitoneal endometriosis lesions.
Treatment
To treat deep pelvic endometriosis, surgery is increasingly used. The goal is to perform the removal of all endometriosis lesions. This surgical procedure is quite complex and will depend on the extent of the disease. A precise assessment of this is made preoperatively by a complete imaging assessment.
A variety of surgical procedures can be performed. There is resection of the uterine torus and one or both uterosacral ligaments. There is also resection of a lesion invading the uterine torus, an area located on the posterior aspect of the uterus at the insertion of two ligaments, which are called the uterosacral ligaments.
To treat deep pelvic endometriosis, the practice of cyst removal, or cystectomy, is possible. The goal is to treat ovarian cysts due to endometriosis. In some cases, there is no other choice than to perform a total hysterectomy. However, the extent of the lesions and the age of the patient are taken into account. Total hysterectomy is summarized as a total removal of the uterus, which is the organ that preserves the ovaries. This removal may concern the body or the cervix of the uterus.
