Free fluid in pelvis?

[Teal09]

I am currently on a waiting list to remove a 7cm endometrioma from my left ovary. I had a 6 month check up with gynae a few weeks ago with TV ultrasound which showed no changes to the cyst. But last week I had an abdominal ultrasound with a urologist (having some bladder issues investigated…) and he mentioned that from what he can see, the cyst is bleeding and there is free fluid in my pelvis. I was on day 5 of my period… my question is, if he’s right, does it mean the cyst is leaking? Or would the cyst normally bleed a bit into my pelvis during my period? I have had steady pain on that left side but nothing dramatic like you’d expect if the cyst had suddenly ruptured… I’m waiting to get his official report and will hopefully be able to pass his findings into my gynae….thanks in advance

[Lindle]

Endometriomas can rupture but you’d know about it - the pain is excruciating. Free fluid is usually more peritoneal fluid than normal which is common with endo due to inflammation.

What is of most concern is that endometriomas are commonly associated with rectovaginal endo but regular sonograghers are not trained to find it. RV endo is mostly left sided. Symptoms you might expect are any combination of lower back pain, pain with or after sex, bowel issues, left leg sciatica and stabbing shooting paid up the bottom or vagina.

You need a more advanced ultrasound or MRI before surgery. If your surgeon is just a general gynaecologist they shouldn’t be operating on you without further investigations and if you are found to have rectovaginal endo you would need referral to a specialist endo centre.

Feel free to message for more guidance. I run a UK endo guidance group called Endorevisited and we have a list of experts in ultrasound.

[Teal09 in reply to Lindle]

Thanks so much for the reply…

Yes the MRI I had showed thickening of the uterosacral ligament and I definitely have a lot of left sided pain, sciatica down the left leg etc…

I asked the gynaecologist (who is just a general one) would that warrant being referred to a centre and she said that’s not what they do, they only refer if they see deep endometriosis once they operate to remove the cyst…. Which seems a bit pointless as it would mean potentially 2 operations rather than 1.

I’m in Northern Ireland. There’s a provisional BSGE centre in Belfast - I called them to ask if I could make a private appointment with the consultant there to get started and they said they are only taking on the confirmed severe cases as their list is so long. So I feel a bit stuck….

Do you know of any trained sonographers in Northern Ireland?

Thanks very much