Ovarian endometriosis: a marker for more extensive pelvic and intestinal disease

Objective: To describe a computerized pelvic mapping system for pelvic and intestinal endometriosis and preliminary insights gained from it with respect to the effects of ovarian disease. Design: Contemporaneous computerized tabulation of pelvic and intestinal sites of biopsy-proved endometriosis. Setting: Tertiary referral center for the surgical treatment of endometriosis. Patient(s): One thousand nine hundred seventy-nine patients with endometriosis, 547 of whom had intestinal endometriosis. Patients with endometriosis with previous hysterectomy (n = 194) with or without castration were excluded from this total, leaving 1,785 patients for this study. Intervention(s): Computer tabulation of sites of biopsy-proved pelvic and intestinal endometriosis. Main Outcome Measure(s): Extent of pelvic and intestinal endometriosis as reflected by number of pelvic or intestinal areas involved. Results were stratified by the presence or absence of ovarian endometriosis and by status of previous therapy. Result(s): Compared with patients without ovarian endometriosis, patients with ovarian endometriosis have more pelvic and intestinal areas involved by endometriosis. Patients with ovarian endometriosis and intestinal endometriosis are more likely to require full-thickness or segmental bowel resections for complete removal of intestinal disease. These findings persisted when adjusted for previous therapies or presence of superficial versus deep ovarian disease. Only 1.06% of patients had ovarian disease exclusively. Conclusion(s): Superficial or deep ovarian endometriosis is a marker for the presence of more extensive pelvic and intestinal disease. Surgeons diagnosing and treating only ovarian endometriosis may be underdiagnosing and undertreating their patients. (C) 1999 by American Society for Reproductive Medicine.