Atypical «masks» of endometriosis in patients with chronic pelvic pain syndrome

Abstract

External genital endometriosis is a common gynecolo- gical disease that affects women of reproductive age and often causes chronic pelvic pain and infertility. The main method for diagnosing the causes of pain in the pelvis, lumbar and sacrum area is magnetic resonance imaging.
Лучевая диагностика, лучевая терапия, функциональная диагностика
64 МЕДИЦИНСКИЙ АЛЬЯНС, том 10, № 3, 2022
MRI is of particular importance in patients with atypi- cal pain that does not have a clear localization. Aim: to determine the most common localizations of external genital endometriosis in patients with atypical pain syn- drome. Materials and methods: retro- and prospective analyses of MR examinations of the pelvic organs per- formed in 48 patients with pelvic pain syndrome, mean age 35 years old. The intensity of the pain syndrome was assessed using the VAS scale. The study was carried out on a GE Signa 1.5 Tesla MRI scanner. Results: main lo- calizations of endometriosis in patients with severe pain were determined. 95.8% of patients had endometrioid cysts of one of the ovaries, and 27% had endometrioid cysts in both ovaries. 35% of patients had signs of a ret- rocervical endometrioid lesion; 26.7% had signs of deep
invasion of the rectum. 2% of patients with severe pain syndrome has lesion of the sciatic nerve and deep infil- trative endometriosis of the pelvic organs. Another 2% of patients with a severe pain syndrome (8–10 on the VAS scale), showed no signs of external genital endometriosis on MRI, but laparoscopy revealed a small endometriotic focus in the retrocervical area. Conclusion: In patients with external genital endometriosis and pelvic pain syn- drome, manifestations of ovarian damage are most of- ten. However, in isolated cases, atypical localization of the external genital endometryosis foci is possible.