A 25-year-old female states that she and her husband have been trying to have a baby for the last two years. The patients medical history included cyclical pelvic pain, dysmenorrhea, dyspareunia, and, not uncommonly, infeility. The physical exam reveals the following: diffuse abdominal or pelvic pain of variable location, nodular thickening and tenderness along the uterosacral ligaments, on the posterior surface of the uterus, and in the posterior cul-de-sac, scarring and narrowing of the posterior vaginal fornix, and adnexal enlargement and tenderness. What is your diagnosis?
Endometriosis is the growth of tissue outside the uterus. The ectopic endometrial tissue can proliferate, and infiltrate, and spread to remote sites elsewhere in the body. Sites that endometriosis is most often found are, ovarian, pelvic peritoneum, anterior and posterior cul-de-sac, uterosacral, round, and broad ligaments, and fallopian tubes. An ectopic pregnancy is one that develops at any site other than the endometrium. Symptoms of an ectopic pregnancy are abdominal pain possible a missed period, abnormal bleeding at the time of presentation is not uncommon. Physical characteristics of an adnexal mass that may give a presumptive diagnosis: consistency (cystic, solid or both), size (in centimeters) morphology and surface contour (smooth, nodular, vague or sharp borders), location around the uterus, mobility (free or fixed to adjacent structures) tenderness, unilateral or bilateral. Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 40. Reproductive Tract Abnormalities. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.
Endometriosis
Ectopic pregnancy
Adnexal mass
Pelvic relaxation