by Tamer Seckin, MD | Posted on January 19, 2021
Pancreatic endometriosis is a condition where tissue resembling the lining of the uterus, or the endometrium grows in and around the pancreas. It can occur with or without classical endometriosis (1).
The pancreas is an organ situated in the abdomen whose role is to produce digestive enzymes and hormones that regulate blood sugar (2). It is surrounded by other organs such as the stomach, small intestine, liver, spleen, and gallbladder (3).
Endometriosis is characterized by tissue resembling the endometrium to grow outside the uterus and form cysts. It usually occurs in and around pelvic organs close to the uterus such as the ovaries and the fallopian tubes (the tubes connecting the ovaries to the uterus). However, in rare cases, endometriosis can also occur in other organs and tissues such as the kidneys (4), appendix (5), pancreas, and even lungs (6).
In pancreatic endometriosis, the extrauterine tissue can lead to pancreatitis or the inflammation of the pancreas (7). It can also form cysts that may bleed, usually in synchrony with the menstrual cycle and cause pain or disrupt the function of the pancreas. Sometimes, scar tissue can form around the cysts and further disrupt the function of the pancreas (1).
Pancreatic endometriosis is very rare with only a few cases reported in the literature. The first cases were reported in 1984 by a group of researchers at The Mount Sinai School of Medicine in New York (8).
The condition has been reported in women ages, 21 to 68 who were still menstruating or in menopause (1).
Like classical endometriosis, it is not known what causes pancreatic endometriosis. Some researchers think that retrograde menstruation or the back flow of menstrual blood up the fallopian tubes could carry stem cells from inside the uterus to other areas, like the pancreas, where they implant and form endometrial lesions (the stem cell theory of endometriosis) (9).
Symptoms of pancreatic endometriosis include:
Pancreatic endometriosis is difficult to diagnose as it is so rare. Imaging tests and needle-guided biopsy can be used to diagnose the condition. The patient’s previous medical history such as the presence of classical endometriosis or pancreatitis can also be useful in reaching a diagnosis (1).
The imaging tests used to diagnose pancreatic endometriosis include ultrasound, magnetic resonance imaging (MRI), and computed tomography (CT).
Ultrasound uses high-frequency sound waves to produce an image of the internal organs (10).
MRI is a non-invasive technique in which detailed three-dimensional images of internal organs are produced using strong magnets (11).
CT uses X-ray images taken from different angles and combines them with the aid of a computer to create detailed images of internal organs as well as bones and blood vessels (12).
None of these imaging techniques is sensitive enough to be able to detect all endometrial lesions and differentiate between endometrial cysts and cancerous ones, however.
A pancreatic tissue biopsy obtained from around the lesions and observed under the microscope can help identify the nature of the lesions. However, this is a more invasive approach compared to imaging techniques.
The pain caused by pancreatic endometriosis can be managed with non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen, or opioid narcotics in cases of severe pain. It is important to remember that opioids are highly addictive and should only be used if prescribed by a healthcare professional and not for extended periods of time.
Other medications that can alleviate the pain caused by pancreatic endometriosis include hormonal treatments like gonadotrophin-releasing hormone (GnRH) receptor agonists and antagonists and hormonal contraceptives.
The surest method of treating endometriosis of the pancreas, especially if it is not clear whether or not the cysts are cancerous, is to remove the affected and surrounding tissues with resection surgery.
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I’ve seen many obgyns over the years explaining my monthly symptoms during my period...but eventually it became a daily struggle with these pain. It feels like a poke here and there near my right pelvic region. I was given birth control pills for the past ten years but honestly, it didn’t help at all. I was in bed whenever I had my period. I was previously sent to GI doctors for possible appendicitis but it was ruled out from imagings…
Dr.Seckin is so much more than a surgeon. His passion for helping endometriosis sufferers and determination to improve the quality of life in all of his patients is undeniable. I remember when my gynecologist first told me I needed a laparoscopy. Her exact words were "I can do the surgery, but if you were MY daughter- I'd send you to him." From the first day I met him he took the time to explain endometriosis to me since I knew…
I was there for hysterectomy but then I found out that I also had endometriosis.My both surgeries went excellent and I feel great!.I am so thankful to Dr.Seckin and all his team for making my journey smooth!
I am a physician who suffered from deep infiltrative endometriosis. I needed laparoscopic surgery, so I went to see my former gynaecologist and he performed the procedure (a surgery which he supposedly does hundreds of times a year) last November. I had severe pain again when I had my period in January and was advised to go on taking a low hormone dose anticoncipient pill. My symptoms came back quickly and got worse in a few months’ time. I went…
After years of excessively painful periods, a serious loss of quality of life, and a series of uninformed and uninterested doctors, Dr. Seckin and Dr. Goldstein turned my life around. I was told I woke up from my surgery almost a year ago with a smile on my face, and I haven't stopped since. Before I heard of Dr. Seckin, I was experiencing almost daily terrible pain to the point where I had difficulty walking, inability to eat, inexplicable weight…
Dr Seckin and his team gave me back my life! Tomorrow will be 1 month since my surgery and I feel great. Dr. Seckin, Dr Liu, and Dr Goldstein are not only beyond words talented and amazing Doctors, but they are also genuinely wonderful and caring people. I cannot say enough great things about Holly, Asiye and Kim as well. They were all caring, kind, patient, and took the time to listen to me and explain anything I needed to…