Ask Dr. Cook Archives
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Recurrent Endometriosis After Total Abdominal Hysterectomy Question: I had a total abdominal hysterectomy and bilateral salpingo-oophorectomy done five years ago. I live in constant, left-sided pelvic pain, and was just diagnosed with having an endometrioma and 3 more cysts. I take hormone replacement therapy. Intercourse is very painful; we have tried different positions, etc., but nothing helps. I do have one child aged 7, but I need info on this pain. Can it be endo on my bowel, bladder, etc.? Answer: It sounds like your surgeon supposedly removed your uterus and ovaries five years ago. But since an endometrioma is usually found in the ovary, this raises the question of whether there is still a piece of your ovary remaining inside. It is actually easier to leave a piece of an ovary during surgery than you might think. The ovary can look a lot like scar tissue, and it lies on top of a fairly large blood vessel. Women with Stage III or IV endometriosis often have ovaries stuck to the pelvic sidewall (with adhesions), and endometriosis around the ureters. When the ovary is removed a portion can be left behind, looking like scar tissue attached to the underlying blood vessel. Often, the surgeon will not clean the "scar tissue" off of the blood vessel, thinking that it is not causing the patient any harm and is not worth the "risk" of operating that close to the blood vessel. If the endometrioma and cysts are on the left side, this is probably the cause of your pain. If you had Stage III or IV endometriosis, it is very possible that you could have developed endometriosis on your bowel (which is the most common site of "recurrence" after a hysterectomy), bladder, or vaginal cuff. Operating on a woman with endometriosis who has had a hysterectomy can be very different than performing surgery on a woman who is undergoing her first laparoscopy. You need to find a surgeon who is experienced in dealing with your type of situation. |
