The accompanying commentary on “deep infiltrating endometriosis” (DIE) – sounds awful doesn’t it ? – in BJOG (February 2011) makes the point that this is nothing less than a “major surgical challenge”. The pelvic anatomy is distorted, the endometriosis “infiltrates” adjacent tissues, and, obliterates the normal surgical planes. It is not surprising that there are so many serious complications.
By the end the authors wonder whether simple medical treatment directed at “interrupting the oestrogen supply to the lesions” may not be more satisfactory. John Sampson promoted this approach in the 1920′s when all he had was oophorectomy (removal of ovaries). In the particular case of nulliparous women with a history of profound straining during defaecation. correcting diet and bowel habit as well as reducing pelvic blood flow (one of the effects of oestrogens to increase pelvic blood flow) may be more productive.
We need some understanding of the causes of these injuries – and some separation of the different groups of women with these serious problems in order to understand what works. It is no good lumping together women with persistent bowel problems and women who have suffered difficult vaginal deliveries ?