Complications in the treatment of patients with endometriosis

Complications may occur as the conservative and surgical treatment during the operation and in postoperative period.
Ignoring available in patients with somatic pathology (chronic of cholecystopancreatitis, cholelithiasis and urolithiasis, varicose veins of the legs, and others) during long-term treatment with hormonal drugs may lead to perforation of the gallbladder (observed in 5 patients), acute pancreatitis (9 patients), aggravation of thyrotoxicosis (11 patients), acute thrombophlebitis of lower extremities and pelvis (15 patients), aggravation of nonspecific polyarthritis (13 patients), aggravation of diffuse neirodermit (5 patients), perforating ulcer stomach (2 patients).
All patients underwent hormone treatment for 3 years and more mostly oral progestins. Available somatic pathology was not taken into account, as in the period of hormonal drugs she was not clinically this horizon manifest itself. In 3 patients, we watched the tromboembolia branches pulmonary artery and the development of heart lung. Hormone treatment were performed for 5 to 12 years.
The examples demonstrate the need for a more thoughtful attitude to long-term hormonal therapy of patients with endometriosis, especially if they have one or another pathology in history and timely review of the treatment strategy is to discuss the problem of surgical treatment, correction of existing medical conditions.
More often complications arise during the operation. On the first place among them should be put damage to the intestines in place of fusion of the intestine with the node POSADSKOGO endometriosis, endometrioid cystadenoma ovaries or when disconnecting growths. In addition, it was necessary to observe penetrating into the lumen of the intestine damage its walls gauze napkins at offset loops of intestine to allow access in the small pelvis. Bad preparation of the bowel, omissions in anesthesia and insufficient relaxation during surgery, cicatricial changes in the bowel wall and decidual reaction stroma nodes of endometriosis in the wall of the intestine contribute to its damage.
Wound hole in the gut sutured by the usual rules. If the area of wound apertures found the site of endometriosis, the question of his removal is decided individually. Under other equal conditions the preference is given to the node excision of endometriosis of the intestinal wall by type wedge resection, unless you want a more serious intervention (resection of the colon, for whatever modifications with the formation of the anastomosis).
Damage to organs of the urinary system can be wound ureter (s), bladder, ligation of the ureter (s) with dissection or without it. Change the topography of the bladder and ureters, involving them in cicatricial inflammatory process and penetration into them of endometriosis contribute to the emergence of complications.
Violation of blood coagulation during operation can occur in the very beginning of the operation and at any stage. The reason for this complication is not fully installed. It is most commonly found in women, long treated with hormones, previous history of hepatitis, viral and toxico-allergic, developed on the ground of long-term treatment with hormones. Extensive traumatic intervention, including the operation on the sex organs, intestines and organs of the urinary system, contribute to the development of complications. The distinctive feature of this type of complication is the predominant manifestation of violation of blood coagulability in the area of operation.
Fighting coagulopathy is held in common for this pathology order (transfusion vegetablegrowing blood solution plasma; introduction kontrikala, dicinon, Gordons, PAMB and other drugs).

  • Ingrowth of endometriosis in the sacrum and thromboembolic complications
  • Postoperative enteroparesis
  • Inflammatory septic complications