Hi all. I have my first Gynaecology appointment at the end of September and I’m hoping to gain some knowledge and information before then.
Earlier this year, I was admitted to hospital with severe lower abdominal pain - an ovarian cyst was found in 2017 and they thought this had ruptured. Ultrasound showed nothing so I was sent for a CT scan. A cystic mass was found in my right iliac fossa region. A pelvic MRI was booked for the following month - I have yearly abdominal MRI surveillance due to Appendix Cancer in 2021.
MRI report came back and it states the following - “Both ovaries demonstrate polycystic morphology. The ovaries are adherent to the lateral walls of the uterus due to endometriosis. The right ovary contains two endometriomas, measuring 1.4cm and 0.8cm. A 2.7cm inflammatory endometrioma/abscess is noted. A 2.5cm long, 0.8cm deep endometriotic plaque is noted in the uterine torus. The right ovary and a segment of the sigmoid colon is adherent to this plaque. Multiple nonspecific subcentimetre mesorectal lymph nodes noted.
Conclusion - Pelvic endometriosis as described above.”
Can someone please explain this to me in English please ie not so medical. I think the latter part of the findings is more to do with my Ulcerative Colitis (diagnosed with UC in 2000 age 10/11), gastro weren’t that concerned about the lymph nodes.
I’m a little concerned about the sigmoid colon being stuck, obviously because of my UC.
What should I be asking at this appointment? Any help or information will be greatly appreciated. Thank you.
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Thank you for replying. I’m having trouble locating someone called Lindie on here, it’s coming up with nothing? But I’ve just followed Rebecca Mallick on Instagram, so I will have a look at her page.
To explain these findings the first thing to say is that endometriosis is a chronic disease where the endometrial tissue, which should only be present in the uterus/womb grows outside the uterus.
'Polycystic morphology' this is purely a fancy medical term we use to say there are multiple cysts within the ovaries
'Endometrioma' these are sometimes known as chocolate cysts. The common consensus is that endometrial tissue grows on or in the ovary. During a period this then bleeds and forms a haematoma (collection of blood). Therefore forming a cyst that is chocolate in appearance, because its filled with blood and endometrial tissue.
'Inflammatory endometrioma/abscess' this is where one of your endometriomas has become infected/seriously aggravated, causing it to fill further with pus and bacteria. Once this has happened it is known as an abscess.
'Endometrial plaque on the uterine torus'
The uterine torus is a small ridge back of the cervix where ligaments (thick bands of connective tissue) attach and extend to the lower spine, these support the uterus within the abdomen.
An endometrial plaque is a growth of endometrial tissue outside the uterus.
So in your case endometrial tissue has grown on the uterine torus. The uterine torus is not usually visible on MRI unless there has been significant thickening, such as with endometriosis. This could indicate deep infiltrating endometriosis.
'Deep infiltrating endometriosis (DIE)' this is where the endometrial tissue has grown outside the uterus and implanted more than 5mm into whatever structure it has grown on I.e the uterine torus.
'Ovary and sigmoid adhered' basically your ovary and sigmoid colon are stuck like glue to the uterine torus. These structures should not be stuck together.
'Mesorectal lymph nodes' are lymph nodes that can be found in the fatty tissue that surrounds the rectum. These could indicate the presence of DIE as they are not usually present within the general population. However, some studies have found that all patients with UC have these present.
I hope this helps, please let me know if I can explain anything further x
Thank you for replying. It’s very informative so I really appreciate that.
I assume the abscess is what originally sent me to hospital with the pain. I had never felt pain like it before so I also assume this is the cystic mass that was first found on the CT - it measured 4.5cm. What would the treatment be for the abscess? Nothing was discussed when being discharged, just told to have paracetamol.
The nodes have grown slightly since a previous MRI but like I said, my gastro consultant isn’t overly concerned about them at the moment. But definitely something I will ask my gynaecologist.
So sorry for the questions but again, thank you for your original reply.
When an endometrioma becomes abscessed it is extremely painful, they are also more prone to rupture or partial rupture. From experience it genuinely feels like you're dying 🙈
With everything the MRI has shown for you, it's most likely to be a diagnosis of stage 4 endometriosis.
You should be offered laparoscopic surgery to remove the endometriomas, endometrial plaques and adhesions. If the nodes have grown since they were last reviewed, it would be beneficial to biopsy to ensure it isn't DIE and is the UC.
They should also offer some form or contraception/hormonal therapy to reduce oestrogen levels, which are known to feed the growth of endometriosis.
They should also offer you testing for your AMH levels, as your fertility is more likely to be effected with stage 4 endo.
If you begin to feel unwell with a known abscess (signs of infection:temperature, feeling clammy, hot/cold, fast pulse etc) you will need to go to ED as an emergency for treatment.
They could put you on prophylactic antibiotics, but they are unlikely do to this unless you're showing signs of infection and blood tests are normal. X
When I was admitted to hospital in April, the pain was pretty horrendous. My pain threshold is quite high and even then I was given morphine for the first time, never felt pain like it. I still get twinges in that area so I’ll definitely mention it when I see the consultant.
Everything you’ve said, I’ve noted it down for my appointment. You’ve helped massively so thank you.
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