ENDOMETRIOSIS INFILTRANTE: REVISIN DE TEMA / DEEP ENDOMETRIOSIS: A REVIEW

摘要

La endometriosis infiltrante o profunda se define como la presencia de lesiones endometriales que infiltran el tejido ms de 5mm, se ubican en el retroperitoneo en sitios diferentes a la endometriosis comn y comprometen diferentes estructuras u rganos como intestino, urter. vejiga, ligamentos tero sacros y regin rectovaginal, pudiendo alterar la calidad de vida de la mujer. Los sntomas ms frecuentes incluyen la dismenorrea, la dispareunia y la disquexia. Una aproximacin al diagnstico incluye la historia clnica con nfasis en los sntomas dolorosos de la endometriosis profunda, el examen fsico con evaluacin de la pelvis y las ayudas diagnsticas que dependen del sistema comprometido y que van desde la eco transvaginal, ecotransrectal y/o resonancia magntica, hasta el colon por enema con doble contraste y la urografa excretora o el urotac. La ciruga es la opcin ms efectiva para el tratamiento en el tiempo dependiendo del sitio de ubicacin y el compromiso de los diferentes rganos; sin embargo, el tratamiento farmacolgico es una conducta vigente y con indicaciones precisas que pudiera ser la opcin principal o complementaria, a pesar de la recurrencias de los sntomas o de las lesiones. Dado que la endometriosis infiltran te o profunda es una enfermedad multisistmica, debe ser manejada por un equipo multidisciplinario. ABSTRACT This paper is a review of infiltrating or deep endometriosis and includes the definition, clinic, diagnostic tools and different options of medical and surgical treatment. Deep endometriosis is defined as the presence of endometrial injuries that infiltrate the tissue in more than 5mm. are located in the retro~peritoneum in different places than the common endometriosis which jeopardize different structures and organs such as: intestine. ureter. bladder. uterosacral ligaments and the rectovaginal area. being able to alter the woman's quality of life. The most frequent symptoms include dysmenorrhoea. dyspareunia and dysquexia. An approach to the diagnosis includes a good clinical history with emphasis in the painful symptoms. physical examination with pelvis evaluation and the diagnostic tools that depend on the jeopardized system and includes transvaginal ultrasound, transrectal ultrasound and/or magnetic resonance, colon by enema with double contrast and the excretory urography or urotae. Surgery is the most effective option for the treatment at this time. depending on the location and the involvement of the different organs; nevertheless, pharmacological treatment with precise indications is a valid conduct and could be the main or a complementary option, in spite of the recurrences of symptoms or injuries. Since the infiltrating or deep endometriosis is a multi-systemic disease. it must be handled by a multidisciplinary team.