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Endometriosis is a medical condition in women where tissue similar to the inner glands of the uterus is deposited in areas outside the uterine cavity. The most common areas where this tissue can grow include the ovaries and pelvic cavity.
Endometriosis is typically seen during the reproductive years of a woman. It is estimated that it occurs in approximately five to ten per cent of females. It is also common in women with infertility.
The disease can be found in bowel, especially the rectum and less commonly small and large intestines as well as the appendix. Other rare sites include surgical scars following caesarian-section and other forms of abdominal surgery. This disease has also been found in the urinary bladder, lungs, spine, and brain and even on the skin.
Endometriosis when present in other organs of the body is influenced by the woman’s hormonal changes and responds similarly to those cells inside the uterus. The common symptom of endometriosis is pelvic pain.
This often occurs during the menstruation, but a woman with this condition may also experience pain which does not relate to her cycle. Pain at sexual intercourse, defaecation and urination may also occur. For many patients, the pain of endometriosis is so severe and debilitating that it affects their everyday normal life.
In many cases, the identification, treatment and removal of adhesions that causes this disease are carried out through the laparoscopic surgery. A full abdominal incision called a laparotomy (a cut in the abdomen) may be required in rare cases for extensive disease, or bowel resections.
A laparoscope is a thin telescope-like instrument approximately 30 centimetres in length. This is inserted into the pelvic cavity through a small cut near the navel. It has a light source and a lens that light up and magnifies the inside of the pelvic cavity.
This helps the gynaecologist to clearly visualise the organs in the pelvis and any endometriosis present. Commonly, two additional half centimeter incisions are made over the lower abdomen through which the surgeon inserts operating instruments for surgical excision of the endometriosis tissue under direct vision.
Dr Timona Obura is Vice Chair, Department of Obstetrics & Gynaecology and a Consultant Obstetrician Gynaecologist and Laparoscopic Surgeon at the Aga Khan University Hospital. Email: [email protected]
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