Redwine, D. B. (1999). Ovarian endometriosis: a marker for more extensive pelvic and intestinal disease. Fertility and Sterility, 72(2), 310-315. https://doi.org/10.1016/s0015-0282(99)00211-3
Redwine DB. Ovarian endometriosis: a marker for more extensive pelvic and intestinal disease. Fertil Steril. 1999;72(2):310-315. doi:10.1016/s0015-0282(99)00211-3
Redwine, David Byron. "Ovarian endometriosis: a marker for more extensive pelvic and intestinal disease." Fertility and Sterility, vol. 72, no. 2, 1999, pp. 310-315.
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Ovarian endometriosis signals more widespread pelvic and bowel disease
Patients with ovarian endometriosis had more pelvic and bowel disease than patients without it. The case series covered 1,785 surgery patients at one referral center. Only 1.06% had disease in the ovaries alone.
Key Findings
Patients with ovarian endometriosis had a mean of 4.39 pelvic areas involved, against 2.96 without ovarian disease (difference 1.43, 95% CI 1.23–1.64), with the ovaries excluded from the count.
Bowel areas involved averaged 0.80 with ovarian endometriosis and 0.24 without. The relative risk of bowel disease when the ovaries were involved was 2.82 (95% CI 2.44–3.26).
Among patients with intestinal endometriosis, ovarian disease carried a relative risk of 1.39 (95% CI 1.16–1.66) for full-thickness or segmental bowel resection.
Only 19 of 1,785 patients (1.06%) had ovarian involvement with no other pelvic area involved.
Complete cul de sac obliteration occurred in 105 of 482 patients (21.7%) with ovarian endometriosis and 75 of 1,303 (5.8%) without.
Interpretation
This case series tracked one surgeon's records at a tertiary referral center. Each patient's disease was mapped as surgery happened and confirmed by biopsy. The same pattern held in the 450 patients with no prior therapy. Superficial ovarian disease went with slightly more pelvic and less bowel disease than endometrioma cysts. The findings support larger studies of ovarian disease as a marker for wider disease.
RRM Context
Restorative reproductive medicine looks for the cause of disease. Mapping where disease sits belongs to that work. Cul de sac disease (1,202 patients) was far more common than disease on either ovary (303 left, 290 right). Surgery in the series was excision, aimed at full removal. The author argues that surgeons who use thermal ablation would avoid cutting into the bowel wall. That choice could turn invasive bowel disease into disease that looks superficial.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objective
To describe a computerized pelvic mapping system for pelvic and intestinal endometriosis and preliminary insights gained from it with respect to the effects of ovarian disease.
Design
Contemporaneous computerized tabulation of pelvic and intestinal sites of biopsy-proved endometriosis.
Setting
Tertiary referral center for the surgical treatment of endometriosis.
Patients
One thousand nine hundred seventy-nine patients with endometriosis, 547 of whom had intestinal endometriosis. Patients with endometriosis with previous hysterectomy (n = 194) with or without castration were excluded from this total, leaving 1,785 patients for this study.
Interventions
Computer tabulation of sites of biopsy-proved pelvic and intestinal endometriosis.
Main Outcome Measures
Extent of pelvic and intestinal endometriosis as reflected by number of pelvic or intestinal areas involved. Results were stratified by the presence or absence of ovarian endometriosis and by status of previous therapy.
Results
Compared with patients without ovarian endometriosis, patients with ovarian endometriosis have more pelvic and intestinal areas involved by endometriosis. Patients with ovarian endometriosis and intestinal endometriosis are more likely to require full-thickness or segmental bowel resections for complete removal of intestinal disease. These findings persisted when adjusted for previous therapies or presence of superficial versus deep ovarian disease. Only 1.06% of patients had ovarian disease exclusively.
Conclusions
Superficial or deep ovarian endometriosis is a marker for the presence of more extensive pelvic and intestinal disease. Surgeons diagnosing and treating only ovarian endometriosis may be underdiagnosing and undertreating their patients.
Endometriosis is a chronic inflammatory disease that drives pain, organ dysfunction, and infertility. How RRM-trained clinicians diagnose and treat it through excision surgery, cycle charting, and longitudinal care.
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