Advertisement

Introduction

  • P. De Nardi
  • S. Ferrari

Abstract

Endometriosis, defined as the presence of endometrial gland tissue and stroma outside the uterus, is a common disease with an estimated prevalence of 10% in women of reproductive age. Deep pelvic endometriosis is a specific entity defined by endometriotic lesions extending more than 5 mm under the peritoneum, usually located in the pouch of Douglas and in the connective tissue of the rectovaginal septum, that may involve the uterosacral ligaments, the rectum or the rectosigmoid junction, and the urinary tract.

Several theories have been proposed for the pathogenesis of deep pelvic endometriosis, namely the implantation of regurgitated endometrium, the theory of Müllerian or coelomic remnants metaplasia, the direct transplantation theory, and the theory of dissemination through the lymphatic and blood vessels.

The most-used classification-system for endometriosis is currently The American Fertility Society revised (r-AFS) classification, but other systems have been proposed by Konincks and Martin, Martin and Butt, Adamyan, and, more recently, by Chapron. Unfortunately, no system is universally shared.

Keywords

r-ASF Peritoneum Cul-de-sac Pouch of Douglas 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Sangi-Haghpeykar H, Poindexter AN 3rd. Epidemiology of endometriosis among parous women. Obstet Gynecol 1995;85:983–992PubMedCrossRefGoogle Scholar
  2. 2.
    Chatman DL, Ward AB. Endometriosis in adolescents. J Reprod Med 1982;27:156–160PubMedGoogle Scholar
  3. 3.
    Missmer SA, Hankinson SE, Spiegelman D et al. Incidence of laparoscopically confirmed endometriosis by demographic, anthropometric, and lifestyle factors. Am J Epidemiol 2004; 160:784–796PubMedCrossRefGoogle Scholar
  4. 4.
    Missmer SA, Hankinson SE, Spiegelman D et al. Reproductive history and endometriosis among premenopausal women. Obstet Gynecol 2004; 104:965–974PubMedCrossRefGoogle Scholar
  5. 5.
    Hediger ML, Hartnett HJ, Louis GM. Association of endometriosis with body size and figure. Fertil Steril 2005;84:1366–1374PubMedCrossRefGoogle Scholar
  6. 6.
    Olive DL, Schwartz LB. Endometriosis. N Engl J Med 1993;328:1759–1769PubMedCrossRefGoogle Scholar
  7. 7.
    Laufer MR. Premenarcheal endometriosis without an associated obstructive anomaly: presentation, diagnosis, and treatment. Fertil Steril 2000;74:S15CrossRefGoogle Scholar
  8. 8.
    Goldstein DP, deCholnoky C, Leventhal JM, Emans SJ. New insights into the old problem of chronic pelvic pain. J Pediatr Surg 1979; 14:675–680PubMedCrossRefGoogle Scholar
  9. 9.
    Yamamoto K, Mitsuhashi Y, Takaike T et al. Tubal endometriosis diagnosed within one month after menarche: a case report. Tohoku J Exp Med 1997; 181:385–387PubMedCrossRefGoogle Scholar
  10. 10.
    Schenken RS. Pathogenesis. In: Schenken RS (ed). Endometriosis: contemporary concepts in clinical management. JB Lippincott Company, Philadelphia, 1989, p 1Google Scholar
  11. 11.
    Bulun SE. Endometriosis. N Engl J Med 2009;360:268–279PubMedCrossRefGoogle Scholar
  12. 12.
    von Rokitansky C. Ueber Uterusdrusen-Neubildung in Uterus and Ovarialsarcomen [Uterine gland proliferation in uterine and ovarian sarcomas]. Zeitschrift Gesellschaft für Aerzte zu Wien 1860;37:577Google Scholar
  13. 13.
    Sampson JA. Metastatic or embolic endometriosis, due to the menstrual dissemination of en-dometrial tissue into the venous circulation. Am J Pathol 1927;3:93–110PubMedGoogle Scholar
  14. 14.
    Meyer R. Uber den stand der frage der adenomyositis und adenomyoma in algemeinen und insbesondere uber adenomyositis und adenomyometritis sarcomatosa. Zentrlbl Gynäkol 1919;43:745–750Google Scholar
  15. 15.
    Gruenwald P. Origin of endometriosis from mesenchyme of the coelomic walls. Am J Obstet Gynecol 1942;44:470–474Google Scholar
  16. 16.
    Donnez J, Nisolle M, Casanas-Roux F et al. Rectovaginal septum, endometriosis or adenomyosis: laparoscopic management in a series of 231 patients. HumReprod 1995; 10:630–635Google Scholar
  17. 17.
    Halme J, Hammond MG, Hulka JF et al. Retrograde menstruation in healthy women and in patients with endometriosis. Obstet Gynecol 1984;64:151–154PubMedGoogle Scholar
  18. 18.
    Liu DT, Hitchcock A. Endometriosis: its association with retrograde menstruation, dysmenorrhoea and tubal pathology. Br J Obstet Gynaecol 1986;93:859–862PubMedCrossRefGoogle Scholar
  19. 19.
    Keettel WC, Stein RJ. The viability of the cast-off menstrual endometrium. Am J Obstet Gynecol 1951;61:440–442PubMedGoogle Scholar
  20. 20.
    Kruitwagen RF, Poels LG, Willemsen WN et al. Endometrial epithelial cells in peritoneal fluid during the early follicular phase. Fertil Steril 1991;55:297–303PubMedGoogle Scholar
  21. 21.
    Olive DL, Henderson DY. Endometriosis and mullerian anomalies. Obstet Gynecol 1987;69:412–415PubMedGoogle Scholar
  22. 22.
    Brosens IA, Puttemans P, Deprest J, Rombauts L. The endometriosis cycle and its derailments. Hum Reprod 1994;9:770–771PubMedGoogle Scholar
  23. 23.
    Vercellini P, Somigliana E, Vigano P et al. ‘Blood On The Tracks’ from corpora lutea to endometriomas. BJOG 2009;116:366–371PubMedCrossRefGoogle Scholar
  24. 24.
    Steele RW, Dmowski WP, Marmer DJ. Immunologic aspects of human endometriosis. Am J Reprod Immunol 1984;6:33–36PubMedGoogle Scholar
  25. 25.
    Oosterlynck DJ, Cornillie FJ, Waer M et al. Women with endometriosis show a defect in natural killer activity resulting in a decreased cytotoxicity to autologous endometrium. Fertil Steril 1991;56:45–51PubMedGoogle Scholar
  26. 26.
    Dmowski WP, Gebel HM, Braun DP. The role of cell-mediated immunity in pathogenesis of endometriosis. Acta Obstet Gynecol Scand Suppl 1994; 159:7–14PubMedGoogle Scholar
  27. 27.
    Witz CA. Interleukin-6: another piece of the endometriosis-cytokine puzzle. Fertil Steril 2000; 73:212–214PubMedCrossRefGoogle Scholar
  28. 28.
    Bacci M, Capobianco A, Monno A et al. Macrophages are alternatively activated in patients with endometriosis and required for growth and vascularization of lesions in a mouse model of disease. Am J Pathol 2009; 175:547–556PubMedCrossRefGoogle Scholar
  29. 29.
    Sinaii N, Cleary SD, Ballweg ML et al. High rates of autoimmune and endocrine disorders, fibromyalgia, chronic fatigue syndrome and atopic diseases among women with endometriosis: a survey analysis. Hum Reprod 2002; 17:2715–2724PubMedCrossRefGoogle Scholar
  30. 30.
    Simpson JL, Bischoff F. Heritability and candidate genes for endometriosis. Reprod Biomed Online 2003;7:162–169PubMedCrossRefGoogle Scholar
  31. 31.
    Campbell IG, Thomas EJ. Endometriosis: candidate genes. Hum Reprod Update 2001;7:15–20PubMedCrossRefGoogle Scholar
  32. 32.
    Thomas EJ, Campbell IG. Molecular genetic defects in endometriosis. Gynecol Obstet Invest 2000;50(suppl 1):44–50PubMedCrossRefGoogle Scholar
  33. 33.
    VanGorp T, Amant F, Neven P et al. Endometriosis and the development of malignant tumours of the pelvis. A review of literature. Best Pract Res Clin Obstet Gynaecol 2004; 18:349–371PubMedCrossRefGoogle Scholar
  34. 34.
    Cornillie FJ, Oosterlynck D, Lauweryns JM, Koninckx PR. Deeply infiltrating pelvic endometriosis: histology and clinical significance. Fertil Steril 1990;53:978–983PubMedGoogle Scholar
  35. 35.
    Koninckx PR, Meuleman C, Demeyere S et al. Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain. Fertil Steril 1991;55:759–765PubMedGoogle Scholar
  36. 36.
    Vercellini P, Frontino G, Pietropaolo G et al. Deep endometriosis: definition, pathogenesis, and clinical management. J Am Assoc Gynecol Laparosc 2004; 11:153–161PubMedCrossRefGoogle Scholar
  37. 37.
    Koninckx PR, Oosterlynck D, D’Hooghe T, Meuleman C. Deeply infiltrating endometriosis is a disease whereas mild endometriosis could be considered a non-disease. Ann N Y Acad Sci 1994;734:333–341PubMedCrossRefGoogle Scholar
  38. 38.
    Nisolle M, Donnez J. Peritoneal endometriosis, ovarian endometriosis, and adenomyotic nodules of the rectovaginal septum are three different entities. Fertil Steril 1997;68:585–596PubMedCrossRefGoogle Scholar
  39. 39.
    Koninckx PR, Martin DC. Deep endometriosis: a consequence of infiltration or retraction or possibly adenomyosis externa? Fertil Steril 1992;58:924–928PubMedGoogle Scholar
  40. 40.
    Nakamura M, Katabuchi H, Tohya TR et al. Scanning electron microscopic and immunohistochemical studies of pelvic endometriosis. Hum Reprod 1993;8:2218–2226PubMedGoogle Scholar
  41. 41.
    Donnez J, Nisolle M. L’endométriose péritonéale, le kyste endométriotique ovarien et le nodule de la lame rectovaginale sont trois pathologies différentes [editorial]. Ref Gynecol Obstet 1995;3:121–123Google Scholar
  42. 42.
    Donnez J, Nisolle M, Smoes P et al. Peritoneal endometriosis and “endometriotic” nodules of the rectovaginal septum are two different entities. Fertil Steril 1996;66:362–368PubMedGoogle Scholar
  43. 43.
    Vercellini P, Aimi G, De Giorgi O et al. Is cystic ovarian endometriosis an asymmetric disease? Br J Obstet Gynaecol 1998;105:1018–1021PubMedCrossRefGoogle Scholar
  44. 44.
    Vercellini P, Busacca M, Aimi G et al. Lateral distribution of recurrent ovarian endometriotic cysts. Fertil Steril 2002;77:848–849PubMedCrossRefGoogle Scholar
  45. 45.
    Vercellini P, Frontino G, Pisacreta A et al. The pathogenesis of bladder detrusor endometriosis. Am J Obstet Gynecol 2002; 187:538–542PubMedCrossRefGoogle Scholar
  46. 46.
    Somigliana E, Infantino M, Candiani M et al. Association rate between deep peritoneal endometriosis and other forms of the disease: pathogenetic implications. Hum Reprod 2004;19:168–171PubMedCrossRefGoogle Scholar
  47. 47.
    Somigliana E, Vercellini P, Gattei U et al. Bladder endometriosis: getting closer and closer to the unifying metastatic hypothesis. Fertil Steril 2007;87:1287–1290PubMedCrossRefGoogle Scholar
  48. 48.
    Bricou A, Batt RE, Chapron C. Peritoneal fluid flow influences anatomical distribution of endometriotic lesions: why Sampson seems to be right. Eur J Obstet Gynecol Reprod Biol 2008; 138:127–134PubMedCrossRefGoogle Scholar
  49. 49.
    Chapron C, Chopin N, Borghese B et al. Deeply infiltrating endometriosis: pathogenetic implications of the anatomical distribution. Hum Reprod 2006;21:1839–1845PubMedCrossRefGoogle Scholar
  50. 50.
    Brosens IA, Puttemans P, Deprest J, Rombauts L. The endometriosis cycle and its derailments. Hum Reprod 1994;9:770–771PubMedGoogle Scholar
  51. 51.
    Vercellini P, Meschia M, De Giorgi O et al. Bladder detrusor endometriosis: clinical and pathogenetic implications. J Urol 1996;155:84–86PubMedCrossRefGoogle Scholar
  52. 52.
    Al-Fozan H, Tulandi T. Left lateral predisposition of endometriosis and endometrioma. Obstet Gynecol 2003;101:164–166PubMedCrossRefGoogle Scholar
  53. 53.
    Parazzini F. Left: right side ratio of endometriotic implants in the pelvis. Eur J Obstet Gynecol Reprod Biol 2003;111:65–67PubMedCrossRefGoogle Scholar
  54. 54.
    Sznurkowski J, Emerich J. Left lateral predisposition of endometrioma. Ginekol Pol 2005,76:33–36PubMedGoogle Scholar
  55. 55.
    Meyers MA. Distribution of intra-abdominal malignant seeding: dependency on dynamics of flow of ascitic fluid. Am J Roentgenol Radium Ther Nucl Med 1973;119:198–206PubMedGoogle Scholar
  56. 56.
    Martin DC, Batt RE. Retrocervical, retrovaginal pouch, and rectovaginal septum endometriosis. J Am Assoc Gynecol Laparosc 2001;8:12–17PubMedCrossRefGoogle Scholar
  57. 57.
    Bonte H, Chapron C, Vieira M et al. Histologic appearance of endometriosis infiltrating uterosacral ligaments in women with painful symptoms. J Am Assoc Gynecol Laparosc 2002;9:519–524PubMedCrossRefGoogle Scholar
  58. 58.
    Chapron C, Liaras E, Fayet P et al. Magnetic resonance imaging and endometriosis: deeply infiltrating endometriosis does not originate from the rectovaginal septum. Gynecol Obstet Invest 2002;53:204–208PubMedCrossRefGoogle Scholar
  59. 59.
    De Lancey JOL. Surgical anatomy of the female pelvis. In: Rock JA, Thompson JD (eds) The Linde’s operative gynecology, 8 edn. Lippincott-Raven, Philadelphia (PA), 1997, pp 63–93Google Scholar
  60. 60.
    Kuhn RJ, Hollyock VE. Observations on the anatomy of the rectovaginal pouch and septum. Obstet Gynecol 1982;59:445–447PubMedGoogle Scholar
  61. 61.
    Baessler K, Schuessler B. The depth of the pouch of Douglas in nulliparous and parous women without genital prolapse and in patients with genital prolapse. Am J Obstet Gynecol 2000; 182:540–544PubMedCrossRefGoogle Scholar
  62. 62.
    Anaf V, Simon P, Fayt I, Noel J. Smooth muscles are frequent components of endometriotic lesions. Hum Reprod 2000; 15:767–771PubMedCrossRefGoogle Scholar
  63. 63.
    Classification of endometriosis. The American Fertility Society. Fertil Steril 1979;32:633–634Google Scholar
  64. 64.
    Revised American Fertility Society Classification of endometriosis: 1985. Fertil Steril 1985;43:351–352Google Scholar
  65. 65.
    Vercellini P, Vendola N, Bocciolone L et al. Reliability of the visual diagnosis of ovarian endometriosis. Fertil Steril 1991;56:1198–1200PubMedGoogle Scholar
  66. 66.
    Martin DC (ed). Laparoscopic appearance of endometriosis, 2 edn. Resurge Press, Memphis (TN), 1991Google Scholar
  67. 67.
    Jenkins S, Olive DL, Haney AF. Endometriosis: pathogenetic implications of the anatomic distribution. Obstet Gynecol 1986;67:335–338PubMedGoogle Scholar
  68. 68.
    Adamyan LV. Additional international perspectives. In: Nichols DH (ed) Gynecologic and obstetric surgery. Mosby, St Louis (MO), 1993, pp 1167–1182Google Scholar
  69. 69.
    Chapron C, Fauconnier A, Vieira M et al. Anatomical distribution of deeply infiltrating endometriosis: surgical implications and proposition for a classification. Hum Reprod 2003;18:157–161PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2011

Authors and Affiliations

  • P. De Nardi
    • 1
  • S. Ferrari
  1. 1.Department of SurgerySan Raffaele Scientific InstituteMilanItaly

Personalised recommendations