I realise this isn't very interesting or would even make much sense to many of you (I had to google every other word), but I thought I would post as it may be useful for fellow endometriosis sufferers.
Laparoscopic ablation of endometriosis, dye test, Hysteroscopy division of uterine septum and insertion of copper coil.
Findings:
1) Uterine Septum
2) Severe Endometriosis/Adenomyosis
Hysteroscopy: Her cervix and cervical canal were normal. The uterus is anteverted and bulky. There was a midline septum bisecting the cavity and extending to the midcavity. The utero-cervical length measured 8cm after division of the septum. Both tubal ostia were seen and are normal. Endometrial biopsy was sent for histology. The midline septum was divided using hysteroscopic scissors until both tubal ostia were visible and the cavity was more regular at the end of the procedure. The uterocervical length of 8cm. Procedure was uncomplicated.
Laparoscopy: There was severe endometriosis involving the rectum which was hitched up to the back of the cervix. There were significant wet endometriosis lesions on the serosal surface of the uterus and on the right pelvic side wall peritoneum. The uterus was soft and adenomyotic in appearance. The right ovary was bulky and contains a haemorrhagic corpus luteum. The left was normal. Both fallopian tubes were freely mobile. There was prompt fill and spill of methylene blue dye from both tubes, confirming bilateral tubal patency. Her peritoneal endometriosis was ablated. The procedure was uncomplicated.
She was discharged home on analgesics and a stat dose of 1g Azithromycin. I have prescribed a course of oestrogen (Progynova 2mg bd) for 28 days to help endometrial regeneration over the area where the septum was divided and Provera 5mg tds from day 18 and for 10 days to induce a withdrawal bleed. The coil will be retrieved in 6 weeks during a second-look hysteroscopy to ensure there are no residual endometrial adhesions. A follow-up appointment has been arranged for post-op review.
Yours sincerely
Mr E Kalu
Consultant Gynaecologist
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