Reconstruction of the Ovary with Endometrioma: A Problem of Adhesions
In situ examination of ovaries with a chocolate cyst has shown that the endometrioma is not an intraovarian cyst of deeply infiltrating endometriosis but an extraovarian pseudocyst consisting of invaginated ovarian cortex fused and sealed off by adhesions and colonized by superficial endometriotic implants. If the adhesions and menstrual bleeding of superficial implants are the cause of the pseudocyst formation, the rational surgical approach is lysis of adhesions and ablation of superficial endometriosis. This chapter describes the nosography of the ovarian endometriotic cyst, the observations that support the thesis of an extraovarian pseudocyst, and proposes adhesiolysis, eversion via the stigma of inversion, and coagulation of superficial implants as the first-choice surgical treatment.
KeywordsCorpus Luteum Ovarian Cortex Eutopic Endometrium Ectopic Endometrium Endometriotic Tissue
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- 1.Russell WW. Aberrant portions of the müllerian duct found in the ovary. John Hopkins Hosp Bull. 1899; 10: 8–10.Google Scholar
- 2.Benagiano G, Brosens I. The history of endometriosis: identifying the disease. Hum Reprod. 1991; 7: 963–968.Google Scholar
- 3.Norris CC. Ovary containing endometrium. Am J Obstet Gynecol. 1921; 1: 831–834.Google Scholar
- 5.Sampson JA. Peritoneal endometriosis due to the menstrual dissemination of endometrial tissue into the peritoneal cavity. Am J Obstet Gynecol. 1921; 14: 422–469.Google Scholar
- 8.Vercellini P, Vendola N, Bocciolone L, Rognoni M, Carinelli S, Candiani G. Reliability of the visual diagnosis of ovarian endometriosis. Fertil Steril. 1990; 53: 1198–1200.Google Scholar
- 13.Nisolle-Pochet M, Casanas-Roux F, Donnez J. Histologic study of ovarian endometriosis after hormonal therapy. Fertil Steril. 1988; 3: 423–426.Google Scholar
- 16.The American Fertility Society. Revised American Fertility Society classification of endometriosis. Fertil Steril. 1985; 43: 351–352.Google Scholar
- 22.Donnez J, Nisolle M, Clerckx F, et al. The ovarian endometrial cyst: the combined (hormonal and surgical) therapy. In: Brosens I, Jacobs HS, Runnebaum B, eds. LNRHAnalogues in Gynaecology. Fort Meyers, FL: Parthenon; 1990: 165–175.Google Scholar