A CLINICAL AND SURGICAL REVIEW OF ENDOMETRIOSIS

Abstract This review is a continuation of one which one of us (Counseller) presented before this Society in June 1938. In that report cases encountered at the Mayo Clinic from 1923 through 1937 were reviewed. This study, being similar, covers the ten-year interval from 1939 through 1948. In these ten years 1,342 patients received surgical treatment at the clinic for endometriosis. This is approximately 25 per cent of the total number of cases of endometriosis encountered during this period. To state it another way, we can say that only 25 per cent of all of the patients presenting evidence of endometriosis were subjected to some type of surgical treatment; the remainder were treated medically. The purpose of this study was to search for certain information or facts which would aid in the selection of treatment for these patients. In order to do this, it is necessary to inquire as to what changes took place in the menstrual cycle and what effect, if any, the previous surgical operations may have had; also, what influence did pain have in disability and, finally, when conservative operations were done, what were the effects, if any, on restoration of fertility and the relief of pelvic pain. In a way, we wish to apologize for adding another paper dealing with the surgical treatment of this disease, but it may be helpful in establishing a unanimity of opinion in the management of this rather serious and disabling disease. Furthermore, this condition has almost replaced the common pelvic inflammatory disease of preantibiotic days. Since blood in the peritoneal cavity is irritating, it may be confused with inflammatory disease in its early stages. In this connection it is interesting to note that therapy, such as hot douches and vaginal diathermy, aggravate rather than relieve the symptoms of endometriosis, which is a distinguishing feature between endometriosis and pelvic inflammatory disease.