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Additional resources for Atlas of Endometriosis, Third Edition ( Encyclopedia of Visual Medicine)
Example text
By palpation the diameter of the lesion can be evaluated. Palpation is often very painful, and the presence of the nodule accounts for symptoms such as deep dyspareunia, dyschezia and dysmenorrhoea. The presence of the disease can be more readily confirmed by examination under anaesthesia for these palpable nodules. 3). CLINICAL FINDINGS Bowel and extrapelvic endometriosis Pelvic endometriosis Clinical findings in endometriosis are markedly variable. In mild cases, routine gynaecological examination is likely to reveal no abnormality.
The pathophysiology of endometriosis may change during its evolution. A more functional classification system of endometriosis is needed. Implants have been found to differ in their functional activity, with red petechial implants producing the highest amount of prostaglandin, brown producing less and black implants producing the least5. Free endometrial implants may be more related to infertility, and active enclosed implants to pelvic pain. The existing classification correlates well with the chance of spontaneous conception.
The best views are the lateral or prone cross-table view of the rectum. qxp 7/25/2007 7:32 PM Page 30 AN ATLAS OF ENDOMETRIOSIS cases in which the bowel is simply displaced by a pelvic endometrioma and cases with bowel involvement. Cases without bowel involvement present as smooth extrinsic masses, while those involving the bowel demonstrate a crenulated or tethered mucosal pattern. Endometriosis involving the bowel wall with crenulation is indistinguishable from a malignant tumour invading the bowel.