Early Endometriosis: Minimal and Stage 1 Peritoneal Endometriosis

What is the definition and cause of early endometriosis?

Early endometriosis is also called minimal endometriosis or stage one disease. Causes leading to the progression of stage one endometriosis to further stages are presently unknown. However, it is known that the peritoneum, which is the lining separating the pelvic organs, bladder, kidneys, and parts of the colon from the rest of the abdomen, is the primary organ involved in early endometriosis.

How do the symptoms differ for early endometriosis?

Early peritoneal disease may be asymptomatic, or silent, but sometimes symptoms of early endometriosis may be severe, especially in adolescents and young women.

How does early endometriosis appear different?

Upon laparoscopic examination of early endometriosis, the pelvic anatomy is seen to be not yet distorted. This means that close inspection and almost near contact of the peritoneal surface with a laparoscopic camera is necessary during the panoramic examination of the pelvis. Many texture changes are visible in differently colored implants. White lesions are usually coverings of underlying active and deep lesions. Red, violet and black lesions precede the fibrotic white lesions. An increasing surface tension of the peritoneum is easily recognized by retraction that appears as circular and longitudinal scarring.

What is angiogenesis and how is it helpful in identifying early endometriosis?

One key identification point that indicates the development of early endometriosis is angiogenesis. Vascular change and formation of new, or enlarging capillary beds is always part of the inflammatory process. Usually, these changes migrate upward from deeper layers up to the surface of the peritoneum as new blood vessels form. This process of new blood vessel formation is called angiogenesis. Different formations of angiogenesis, including elevation, spiral formation and budding (also called sprouting) may be identified easily with Aqua Blue™ inspection technique. Increased vascularity along with new nerve formation might explain the unparalleled pain in cases of early to late endometriosis.

Where is early endometriosis usually located?

The most common peritoneal location for early endometriosis is where the ovary rests and where tubal openings are in contact, which is called the ovarian fossa and uterosacral plate.

What causes early endometriosis symptoms?

Endometriosis typically occurs in the lining of the organs in the pelvic and intra-abdominal areas (peritoneum). Even in an early stage of disease, the lesions containing endometrium-like stroma and glands are hormonally reactive and associated with increased immune system activity and inflammation. These particular implants cause chronic recurrent bleeding and inflammation, which can ultimately lead to fibrosis (thickening and scarring of the areas affected).

Who is most affected by early endometriosis?

An early, active form of the disease is common in younger patients, yet evasive despite severe symptoms of dysmenorrhea and gastrointestinal discomfort.

How can early endometriosis be treated

Treatment for early endometriosis on the peritoneal is done through wide excision aimed to remove not only the typical atypical lesions but also collateral pathology caused by inflammation. These defects, named Leopard Spots, are recognized instantaneously by retroperitoneal Aqua Blue™ water contrast created by a hydrodistention. Wide and deep excision achieved by this method, sparing the healthy peritoneum, is different than a peritonectomy (removal of cancerous peritoneum itself), which is the common procedure that most surgeons will perform. A peritonectomy is often unnecessary in cases of early endometriosis, but there are still many surgeons who believe it is the proper solution due to a lack of knowledge.

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