The etiology and pathogenesis of endometriosis

Theory of the origin of endometriosis in detail covered in the literature and analyzed in the monograph B. N. Baskakov (1966). Therefore, in this paper they will be considered briefly, only in the aspect of the clinic and treatment parsed pathology:
1. Embryonic and dysontogenetic theory is attracting more attention in connection with increase of frequency of endometriosis at a young age.
The essence of embryonic theories is that endometriosis develops from displaced sections of the embryonic material of which are in the process of embryogenesis formed genitalia of women and, in particular, the endometrium. F. Reklinghausen (1893, 1895, 1896), R. Kossmann (1897), H. I. Horizons (1911) allowed the development of endometriosis of the remnants Volfovich phone
So Cullen (1896), Pfannenstiel (1897), W. Russell (1899), R. Meyer (1903), E. Ferroni (1902) and others thought that endometriosis develops from residues mullerova ducts.
Pathological studies of the fruit of man and animals that is, Ferroni (1902), R. Meyer (1903), O. B. Levinsky (1940) and others have confirmed the possibility of embryonic origin of endometriosis.
Detection of clinically active endometriosis at a young age from 11 to 12 years, i.e. in the first years after the beginning of menstruation, and the combination of endometriosis with anomalies of genital organs, organs of the urinary tract and gastrointestinal tract confirm validity of embryonic or dysontogenetic theory of the origin of endometriosis. Century Schifrin (1973) reported on 15 patients aged 12 to 20 years, 6 of which were congenital anomalies sexual apparatus (bicornuate uterus, extension uterine horn, stenosis hymen and others); 2 patients - congenital anomalies one kidneys; 2 sick soon after birth were operated on for closing of the developmental anus.
Symptomatic endometriosis under 19 years in 18 patients described J. Bullock et al. (1974).
In the clinic of gynecology military medical Academy im. S. M. Kirov was observed in 13 patients with endometriosis at a young age (from 11 to 24 years).
Patient K., 14 years. Ill since the age of 10 with the onset of menstruation, which, like the rest, was accompanied by very strong attacks of abdominal pain, loss of consciousness, nausea, vomiting, bloating. Before admission to the clinic moved 3 operations: over the proposed appendicitis, adhesive obstruction (both diagnosis was not confirmed) and exploding "chocolate" endometrioid cysts right ovary. All operations did not reduce the suffering of the girls. The clinic operated at the age of 14. Was deleted right extension uterine horn 15X18X20 cm, produced excision of endometriosis thin, large bowel and bladder, the removal of the vermiform process cecum affected by endometriosis, and excision of endometriosis postoperative scar formed after 6 months after the removal of chocolate cyst of the right ovary. During the operation the detected change the location of the internal organs. Before the operation method excretory urography found no right kidney. The uterus and left appendages it has not been changed and correspond to the age of the patient. After surgery, the pain was gone, instruire regularly. Unfortunately, the dynamic monitoring of the condition of the patient could not be realized.
Similar operations were performed another 4 patients aged 20 to 25 years who have clinical symptoms of endometriosis appeared with 10-12 years and coincided with menarche.
It is interesting to note that from 92 patients, including patients of older age who have the diagnosis of congenital endometriosis, according to a retrospective analysis of the history of the disease, is very probable, 6 was discovered endometriosis, bladder, 9 - endometriosis incremental horns of the uterus, 4 - double uterus, in 2 - doubling sexual apparatus, 4 - congenital absence of one kidney, the 2 - the location of one kidney in the field of small pelvis (the length of the ureter, according to the data of x-ray examination, about 7 cm), 1-u kidney, 2 - a doubling of the ureter, 5 - congenital heart defects, in 3 - 4 toes on the feet and 1 - change location of the abdominal cavity. Thus, in 33 out of 92 patients of this group (1/3) concurrently with genital endometriosis it was possible to observe certain deviations in the structure of sexual or other organs, and 6 - congenital bladder endometriosis.
Literature data and our observations show the failure of the objections of opponents of embryonic theories [B. N. Vinogradov, 1929; Zeev M. A., 1957; Harbitz N., 1934; Ranney Century, 1948, and others].

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