Genital endometriosis and syndrome Allen-masters

Syndrome Allen-masters [Allen W., W. Masters, 1955] due to traumatic rupture of ligaments of the uterus, mainly fascial tissue wide uterine ligaments, cardinal and Sacro-uterine ligaments. The cause of the injury can be childbirth large fetus, birth in the pelvic presentation, fast delivery, abortion, sometimes gynecological laparotomy and tight tamponade of the vagina.
The syndrome Allen - masters in many respects similar to the symptoms of genital endometriosis. In addition, both pathologic process may be combined [Le Bourg, Bouchard, 1971; Savitsky, A., 1978].
Typical complaints syndrome Allen-masters are a pain in the lower abdomen, pelvis and lower back. The pain intensifies 48 h before and during menstruation, can take cramping character and be accompanied by nausea and headaches. Dysmenorrhoea is often combined with menorrhagia. Pain deep in the pelvis can wear burning, arching nature and be accompanied by pressure on the rectum, irrationality in the limb, sometimes up. Before and during menstruation pain in the rectum when urinating. In addition, pain during sexual intercourse, fatigue, tiredness. Physical stress and long stay on his feet also lead to greater pain. Most patients receive emotional turmoil, tearfulness, up to acute depression. Patients lose the ability to work from pain.
Objective examination is defined by some increase of the uterus (respectively term in 5-7 weeks of pregnancy). The uterus is always in the position of retroversion stage III. The cervix is easily displaced in all directions, the body of the uterus relatively stable ("articulating the neck"). The study is accompanied with sharp pain, especially when the pressure on the back surface of the cervix (shift it forward). Palpation of the uterus is also painful.
Thus, if we exclude the symptom mobile ("hinge") of the cervix, the clinic and objective data syndrome Allen-masters quite similar to the picture of genital endometriosis. It should be added detection during laparotomy in dopasowa pocket serosanguineous fluid in the number of 80-100 ml Latter is associated with the rupture of the peritoneum and ligaments of the uterus, as well as venous congestion in small pelvis and internal genital organs.
Ligaments of the uterus is one - and two-sided, and with a wide uterine ligaments can spread on their base (cardinal ligament) and Sacro-uterine ligaments. Through gaps in a wide uterine ligaments (the latter have slit-like or oval shape and are parallel to the cervix) are varicose-enlarged veins, tortuous artery and the ureters.
Diagnostics articulated syndrome" is based on the complaints, the study of obstetric anamnesis (the genera large fetus, surgical delivery, and so on), data laparoscopy, Chrismation venography and operating finds.
About this syndrome is necessary to mention in view of the similarities and possible combination with genital endometriosis; in addition, there are differences in the treatment of both diseases. The thing is that with traumatic rupture of ligaments of the uterus on the success of conservative treatment can not count. Helps only surgical treatment.
In recent years, the combination syndrome Allen-masters and genital endometriosis (ovaries, peritoneum uterine-pryamokishechnye deepening, back of the neck of the uterus and pozavcherashny localization) in young patients we surgical treatment in the following amounts. After excision of the foci of endometriosis within unchanged tissues and peritonization zone operations (with the exception of the ovaries) usepam nylon or silk threads defects rear leaves wide uterine ligaments. Pre carefully allocated to the ureters and together with varicose-dilated veins are shifting them from the zone of the suturing to the unchanged parts of the wide uterine ligaments. This measure is intended to prevent damage to veins and flashing of the ureter. If the defect in the back of the TIR wide uterine ligaments is insufficient size and (or) themselves sheets strongly thinned, they dissected, their edges are captured soft clips, and then it is mixed veins and ureter from the edges of the cut. After this round of uterine ligaments are fixed to the rear surface of the uterus on Baldi-Artigo. In the postoperative period is integrated maintenance therapy. Some patients have to spend treatment of coccygodynia and pelvic plexitis, which often develop when combined syndrome Allen - masters and genital endometriosis.
Great difficulties in diagnosis occur in the presence of a combination of endometriosis of the isthmus of the uterus and traumatic injuries of ligaments of the uterus (syndrome Allen - masters). These patients suffer particularly difficult not only from the constant debilitating pain during menstruation become very strong and painful, but from what doctors for a long time unable to establish the cause of their suffering. There are cases of unfounded accusations of patients in the simulation. In patients developing astenoipohondricheskih syndrome with severe depression.