25 years ,G0P0, with primary infertility for 4 years with no other complain.HSG revealed bilateral fimbrial block .US showed no hydro or pyosalpinx.laparoscopy revealed violin string perihepatic adhesions ,omental adhesion to back of uterus and to uterovesical pouch with endometriotic spots and bowels adhesions to lateral pelvic wall.
this looks more like a case of endometriosis with pelvic adhesions secondary to endometriosis although one can distinguish fresh endometriotic lesions from the colour and the involvement of uterosacral ligaments and ovariesand a detailed history along with take help of ca25 levels which are likely to be raised and ruling out history ofr any active PID and taking the EBPCR with the kind of tough adhesions in the omentaum and with uterus and conspicuous absence of oarian involvement but typical bluish red lesions help one to distinguish even in isolated endometriosis etc.
does violin like strings of perihepatic adhesions (chronic FUTZ HUGH CURTIS sundrome) occur with endometriosis ?
never take anything for granted as i had a patient,young unmarried girl with hydatid cysts in the liver along with huge endometriomas in the pelvis and one of the toughest case i tackled as this pt had been laparoscopically tackled by a surgeon regarding endometriosis drainage but left as it is because of assive size ad in end she ended up rupturing the hydatid cyst in peritoneL CAVITY AND IN SHOCK THE ASURGEON GAVE A HUGE LINEAR INCISION T5O DRAIN AND SAVE LIFE BUT LSTER MANAGEMENT WAS V TOUGH HER CA25 WAS 625 ,but nothing used to work later in the encysted cysts trying to sclerose the cavity and she would be in constant pain and haemoglobin galling -redceived ATT as well but nothing relieved her pin.
its difficult to be sure of the diagnosis without histological examination
Although histological diagnosis is gold standard, it is usually assumed that in endocmetriosis, surrounding dense adhesion with chocolate coloured fluid contents are usualy present and after adhesiolysis, usually there are oozing from the adhesion beds.
Histology is needed, the coexistence of endometriosis and Clamydia is described
regards
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