Case Report
Case Report
Case Report
ENDOMETRIOSIS
Written By :
Muhammad Fadhil
CONSELOUR : dr. Ni Made Indri, Sp.OG
Definition
Endometriosis is a disease in which endometrial
Epidemiology of Endometriosis
This disease affects 5% to 10% of women of
reproductive age
The highest incidence of endometriosis is in women who
Etiologies of Endometriosis
Sampson's theory: Retrograde menses
Immunogenic defect
Clinical Presentation
Pelvic pain
Infertility
Pelvic mass
Pelvic Pain
Frequency
Cyclic: Variable length prior to and after
menses
Acyclic: constant and unrelenting
Associated activities
May include dyspareunia, dysuria
Infertility
Moderate to severe disease
Adhesions
Distortion of normal anatomy
Prevent sperm-egg interaction
Physical Findings
Tender nodules along the uterosacral
mass
Diagnosis of Endometriosis
Direct visualization of implants
Laparoscopically or Laparotomy
Conscious pain mapping
Imaging of endometriomas
MRI appears to be best (3 mm implants)
Ultrasound helpful in office setting
Biochemical markers
Lack specificity
Treatment of Endometriosis
Management of pain
Surgery
Medical therapy
Treatment of infertility
Surgery
Ovulation induction
Assisted reproductive technology
Management of Pain
Surgical treatment
Ablation of endometrial implants
Lysis of adhesions
Ablation of uterosacral nerves
Resection of endometriomas
Treatment of Pain
Medical management
Treatment of Infertility
Removal of disease
Surgery improve conception rates at all stages
Ovulation induction
Gonadotropins with ovarian suppression
Insemination with either clomiphene or FSH
Medical suppression of ovarian function
No benefit
Assisted reproductive technology
Case Report
Personal Data
Name : Miss.R
Age
: 24 years old
Sex : Female
Marital Status : Single
Address : Indonusa Housing Block F No.5
Profession : Student
Religion : Islam
Ethnic : Minang
Education: Senior High School
Date of Admission : 18-10-2016
Medical Record Number : 162041
Anamnesis
Main reason for visit : palpable lump in the area of the pubic symphysis
Other complainment : (-)
Present History Illness :
Physical Examination
GA
Cons
BP
PR RR
T Body Weight
Body Height
Mdt CMC 130/80 81 22 36,7 43 kg
150 cm
Eyes
: Conjunctiva wasnt anemic, Sclera wasnt icteric
Neck
: Tyroid gland no enlargement
Chest
: Normal
Abdoment : Gynaecological record
Genitalia : Not checked
Extremity : Edema -/-, Physiological Reflex +/+, Pathological Reflex -/Gynecologic Record :
Abdoment:
I
: slightly enlarge
Pa : A smooth solid mass (+),palpable lump in the area of the pubic symphysis.
Pe : Tympanic
Au : Peristaltic sound was normal
USG :
-Uterine size normal
- Look mass with size I : 10 x 9 x 9 cm dan II : 10 x 9 x 9
Cont
Diagnosis pre op : Ovarium cysts with differensial diagnosis
Endometriosis cysts
Planning : -Observation general state and vital sign
- Consultation to docter Sp.An, Sp.B, and Sp.PD
Advise : preparation Laparotomy
Report of the operation :
Inferior midline incision
Exploration, looking gray colored cystic mass of the babys head coming
Cont
Discussion
Was the diagnosis in this case correct?? Yes
- Age of patient is 24 years old, which still relatively
productive age
Showed the right symtoms, like :
- Pelvic pain
- Irreguler menstruation
Cont
Case
Theory
Pelvic examination
findings of :
- An enlarged, irregulary
menstruation
Imaging can be find :
- Look mass with size I : 10
x 9 x 9 cm dan II : 10 x 9 x 9
Cont
Case
Theory
Laparotomy on 19 oct
2016
treament of
endometriosis cysts
based on symtopatolgy,
surgerically or
combination of both