Anatomical Distribution of Deep Infiltrating Endometriosis and Its Relationship to Pelvic Pain

Abstract

Background: Deeply infiltrative endometriosis (DIE) is found in many anatomical locations in the pelvis and causes chronic pelvic pain (CPP). Objective: The goal of this research was to investigate the relationship between several types of pelvic pain with anatomical locations of DIE lesions. Materials and Methods: This was a retrospective observational study that included 59 women who underwent surgical exeresis of DIE. Clinical and surgical data were collected on the anatomical locations of lesions (uterosacral ligaments, retrocervical, rectovaginal septum, vagina, bowel, bladder, and others), and pelvic adhesions. Multivariate analysis and logistic regression were used to study the relationship between the types of pelvic pain and sites of DIE as well as the locations/extents of pelvic adhesions. Results: Most women presented with more than one type of pelvic pain (46; 78%) and multifocal DIE (36; 61%). DIE was more frequently encountered in the bowel (40; 34.2%) and uterosacral ligaments (31; 26.5%). Deep dyspareunia was associated with vaginal DIE (odds ratio [OR]: 3.17; 95% confidence interval [CI]: 0.9-10.7) and rectovaginal septum DIE (OR: 4.42; 95% CI: 1.0-19.3). Pelvic adhesions in the cul-de-sac were associated with dyschezia (OR: 7.58; 95% CI: 0.9-66.3) and intestinal DIE (OR: 10.2; 95% CI: 2.79-37.3). Conclusions: Deep dyspareunia was associated with DIE in the vagina and rectovaginal septum. Dyschezia was related to cul-de-sac adhesions, whereas intestinal endometriosis was associated with cul-de-sac obliteration. Specific types of pelvic pain may be predictive of DIE locations and can be used to help plan surgical interventions. ( J GYNECOL SURG 32:99)

The Clinical Anatomy of Endometriosis: A Review

“…In endometriosis, the endometrial tissues spread from the uterus to other pelvic organs, such as the ovaries and fallopian tubes [ 1 - 2 ]. Deep infiltrating endometriosis (DIE), defined as the presence of endometriotic implants greater than 5 mm beneath the peritoneum, is a major indicator of the severity of pain women with this disorder experience [ 22 - 23 ]. A retrospective observational study of women who underwent a surgical procedure to remove DIE lesions showed that most women with this condition present with multiple forms of pelvic pain, in which the bowel is the most frequent location of pain, followed by the uterosacral ligaments [ 22 ].…”

“…Deep infiltrating endometriosis (DIE), defined as the presence of endometriotic implants greater than 5 mm beneath the peritoneum, is a major indicator of the severity of pain women with this disorder experience [ 22 - 23 ]. A retrospective observational study of women who underwent a surgical procedure to remove DIE lesions showed that most women with this condition present with multiple forms of pelvic pain, in which the bowel is the most frequent location of pain, followed by the uterosacral ligaments [ 22 ]. Avila et al observed further that deep dyspareunia was associated largely with vaginal and rectovaginal septum DIE, with dyschezia related closely to adhesions in the cul-de-sac [ 22 ].…”

“…A retrospective observational study of women who underwent a surgical procedure to remove DIE lesions showed that most women with this condition present with multiple forms of pelvic pain, in which the bowel is the most frequent location of pain, followed by the uterosacral ligaments [ 22 ]. Avila et al observed further that deep dyspareunia was associated largely with vaginal and rectovaginal septum DIE, with dyschezia related closely to adhesions in the cul-de-sac [ 22 ]. DIE also has been reported in the urinary tract, with bladder and/or ureteral involvement, and is prevalent in 6% of women with pelvic endometriosis [ 23 ].…”

To operate or not to operate on women with deep infiltrating endometriosis (DIE) before in vitro fertilization (IVF)

“…Despite its low sensitivity and specificity, vaginal examination and evaluation of specific symptoms should not be completely ruled out in the basic diagnosis of endometriosis or in the planning of further therapeutic interventions ( Carneiro et al , 2013 ; Ávila et al , 2016 ).…”

“…DIE is considered a specific entity which has been arbitrarily defined in histological terms as endometriotic lesions extending more than 5mm underneath the peritoneum ( Cornillie et al , 1990 ; Koninckx et al , 1991 ). DIE is responsible for painful symptoms, whose severity has been strongly correlated with the anatomical location of the DIE lesions ( Ávila et al , 2016 ).…”