High risk case of grade 4 endometriosis
Grade 4 endometriosis with bilateral chocolate cyst rt (80x80x42m) cyst & left cyst (60x57x48m)
After GA, scope inserted.On examination, the whole abdomen was studded with endometriosis. Abdominal wall,Omentum, all surfaces of intestines, epigastric area, pelvic area everything were of dirty look due to endometriotic material spillage.
In pelvis – two huge ovarian mass were seen as if “kissing” each other behind the uterus in pouch of Douglas. Both Mass were firmly adherent to all surrounding surfaces. Rt sided cyst got punctured and dirty chocolate fluid drained out. Rt ovary with cyst wall first separated out from mesosalpinx posteriorly. Thick cyst wall was removed.
Lt sided cyst was punctured and old haemorrhagic fluid drained out. Cyst wall removed after lt ovary separated out from surrounding wall.
Because rt cyst wall was very big and thick,2 stiches were taken on ovary with vicryl 1-0.
Throughout the surgery NS wash was given off & on. After removal of all pathology,3 litres of NS wash given in abdominal cavity. As far as possible endometriotic material washed out. Closure done.
Her post – op period was uneventful, discharged on 2nd day with advice of lupride injection.