chocolate cyst
Introduction
Introduction to chocolate cysts A chocolate cyst is a "tumor" but not a "tumor". It is a disease of endometriosis. Under normal circumstances, the endometrium grows in the uterine cavity, and the effect of female hormones in the recipient falls off once a month to form menstruation. If the endometrial debris that falls off during the menstrual period enters the pelvic cavity with the menstrual blood flowing through the fallopian tube, it is implanted on the surface of the ovary or other parts of the pelvic cavity to form an ectopic cyst. This ectopic endometrium is also affected by sex hormones, and it is repeated with the menstrual cycle. Shedding bleeding, such as lesions occur in the ovary, each time there is bleeding in the menstrual period, so that the ovary enlarges, forming a cyst containing old blood, this old blood is brown, sticky like a paste, like chocolate Therefore, it is also called "chocolate cyst". This cyst can be gradually enlarged, sometimes rupturing during menstruation or after menstruation, but rarely malignant. Chocolate cysts can be seen in the endometrial tissue under the peeping hysteroscopy. Because of the old bloody sputum in the cyst, such as chocolate paste, it is called "chocolate cyst". Although there are only small cysts in the beginning of this disease, but delaying the treatment for a long time, or insisting on taking the medicine, each time the menstrual cramps before and after the abdominal pain is severe, the patients are mostly due to ectopic endometrial tissue, the influence of ovarian hormones Next, periodic changes such as periodic congestion, hemorrhage and exfoliation occur, so it is also called "ovarian endometriosis". basic knowledge The proportion of illness: 0.003% Susceptible people: women Mode of infection: non-infectious Complications: infertility, dysmenorrhea, irregular menstruation, peritonitis
Cause
Causes of chocolate cysts
Body factor (55%):
The chocolate cyst is due to the ectopic endometrial growth in the pelvis. This endometrium also has a menstrual-like hemorrhage every month. These bleedings accumulate in the pelvis and other places and become cysts. Cysts are often bilateral, the contents of the cysts are menstrual blood, in which the water is absorbed, the blood is concentrated into a dark brown, viscous paste, which looks like chocolate and is called a "chocolate cyst."
Age factor (40%):
Chocolate cysts mainly occur in young and middle-aged women between the ages of 30 and 40. Mainly due to the menstrual period of the uterine wall shedding of the endometrial debris due to poor drainage, can not be completely discharged from the vagina, a small amount of the fallopian tube back to the pelvic cavity. The cause of ovarian chocolate cysts is not clear, environmental factors, living habits, mental state, etc. may be related to the incidence of ovarian cysts, but has nothing to do with married unmarried. Therefore, ovarian cysts can occur in any age group, generally high in women aged 20-50, unmarried women suffering from menstrual disorders, decreased menstrual flow and even abdominal pain, etc., should be vigilant, timely check, especially fat Young women need to pay more attention.
Other factors (5%):
(1) Dysmenorrhea: the main symptom of chocolate cysts, and also the most easily overlooked symptoms, secondary and increasing year by year, but there are also a few patients without obvious dysmenorrhea.
(2) irregular menstruation: menorrhagia, menstrual blood volume, is also one of the common clinical symptoms of chocolate cysts, the general menstrual cycle is characterized by excessive menstrual blood or a long period of time.
(3) Sexual life pain: This is also an obvious disease signal. Patients may also have drip-like bleeding, which is often more obvious before menstruation.
(4) Infertility: Chocolate cysts can cause women to become pregnant, and their infertility rate is about 50%. Infertility accounts for a high proportion of infertility caused by chocolate cysts.
Disease mechanism
1. Endocrine factors: Although the ovary is small, it is one of the important organs that produce eggs and ovulate, balance endocrine, and often has a proliferative age of endocrine. Therefore, it is considered to be related to endocrine disorders. In addition, when the menstruation is angry, it may be gone, the garbage can not be discharged, and a cyst is formed in the ovary.
2, frequent sexual life: usually the majority of the disease is in adolescent girls and more women, which is related to their excessive sexual life.
3, fallopian tube obstruction: no fertilized follicles in the ovary, waste waste to be discharged, you need to rely on the body hydraulic pressure to discharge the garbage, because the function declines, the fallopian tube is blocked, the eggs that can not be discharged in the ovaries, formed Cyst.
4, excessive pressure: is the main cause of ovarian chocolate cysts, long-term mental stress, can lead to autonomic dysfunction, affecting endocrine regulation, leading to premature ovarian function decline, estrogen secretion decreased, early into menopause .
Prevention
Chocolate cyst prevention
8 preventive measures for ovarian chocolate cysts:
1. Pay attention to adjusting your emotions, maintain an optimistic and cheerful attitude, and make the body's immune system function properly.
2, should pay attention to their own warmth, to avoid cold and cold.
3. During the menstrual period, all vigorous sports and heavy physical labor are prohibited.
4, if you have been diagnosed with endometriosis, ovarian chocolate cysts greater than 6cm or more, in the menstrual period or mid-menstrual period must pay attention to maintain emotional stability, to avoid overwork, once the intracavitary tension suddenly rises, When the wall of the capsule is broken, it will form an acute abdomen.
5, try to do less abortion and curettage, do a good job in family planning.
6, women must mend menstrual period to prohibit sex.
7, girls should avoid being frightened during adolescence, so as not to cause amenorrhea to form an overflow.
8, prevention of ovarian chocolate cysts should pay attention to menstrual period to do their own health care, pay attention to control their emotions, do not sulking, otherwise it will lead to endocrine changes.
Complication
Chocolate cyst complications Complications infertility dysmenorrhea menstrual irregular peritonitis
Infertility
About 50% of patients with endometriosis are associated with infertility, and about 30-40% of patients with unexplained infertility suffer from endometriosis. Endometriosis suffers from infertility, often caused by pelvic mass, adhesion, oviduct occlusion follicle development or ovulation disorders; and once ectopic, the ectopic endometrium is inhibited and atrophied, which is very important for endometriosis Good treatment, some of the habitual abortion cases are caused by endometriosis.
Dysmenorrhea
The clinical features of endometriosis are progressive dysmenorrhea, which is a common and prominent feature, mostly secondary, that is, from the occurrence of endometriosis, the patient complained that there was no pain in the past menstrual cramps, but began to appear from a certain period. Dysmenorrhea can occur before menstruation, menstruation and after menstruation. Some dysmenorrhea is more difficult, need to rest in bed or medication to relieve pain, and even painful "rolling" or hit the head, the pain often aggravates with the menstrual cycle, and disappears after the end of menstruation, but domestic reports have 21% about no dysmenorrhea.
Periodic rectal irritation: progressive rectal irritation with progressive exacerbations is rare in other gynaecological diseases and is the most valuable symptom for the diagnosis of this disease. The rectum, anus, and genital area swell, fall pain, and feel heavy and frequent stools. As the lesions worsen, the symptoms become more pronounced and the symptoms disappear after the passage.
Irregular menstruation
Patients with endometriosis often have shortened menstrual cycle, increased menstrual flow or prolonged menstruation, indicating that patients have ovarian dysfunction. Irregular menstruation can be used as a diagnostic reference, but it is of no value in differential diagnosis.
Sexual pain
Sexual analgesia can occur when there is an ectopic endometrial nodule of the vagina, a rectal depression or adhesion, or an ovarian adhesion to the pelvic floor. When the fibrosis and contraction of the posterior lobe of the broad ligament is obvious, the ureter can be exogenously compressed, and the stenosis can be blocked, and urinary system symptoms may occur. Severe ureteral hydrops or hydronephrosis may occur.
Periodic bladder irritation
When endometriosis affects the bladder peritoneal pleats or invades the bladder muscle layer, symptoms such as urinary urgency and frequent urination may occur at the same time. If the lesion invades the bladder mucosa (bladder endometriosis), there is periodic hematuria and pain.
Acute cystic abdomen before or after menstruation of chocolate cysts: generally ovarian endometrial cysts, which are characterized by perforation. Most patients have emergency surgery due to ovarian cyst torsion or ectopic pregnancy. If you do not get better with surgery, the pelvic adhesions will increase, and there will be repeated ruptures in the future.
Periodic lower abdominal discomfort
The incidence of this symptom is higher than dysmenorrhea, and patients with endometriosis without dysmenorrhea often present in this symptom. Appears in mild patients, or some lesions are heavier, but due to personality differences in pain threshold or other reasons, do not produce dysmenorrhea symptoms and only menstrual backache, lower abdomen bulge discomfort.
Endometriosis of the abdominal wall and uterine endometriosis have periodic localized masses and pain. Patients with intrinsic endometriosis tend to swell, but rarely exceed 3 months of pregnancy. If it is the posterior uterus, it is often fixed. In the uterus rectal fossa, uterine ligament or posterior wall of the cervix often touch 1-2 or more hard small nodules, such as mung bean or soybean size, more obvious tenderness, more obvious anal diagnosis, this is very important . Ovarian cysts can grow to a large size. Because of the cystic contents spilling out and ectopic endometrial hemorrhage, the pelvic organ adhesions are aggravated into frozen pelvic cavity, which is called extensive endometriosis. Signs vary greatly when the severity of the lesion is different.
peritonitis
A chocolate cyst that grows in the ovaries. The walls of the capsule are often very brittle and have a tendency to spontaneously rupture. After the cyst is ruptured, the small rupture can quickly heal itself and form adhesion with the surrounding tissue; if the rupture is large, it will not heal itself, and the thick chocolate-like sac fluid can flow into the abdominal cavity. This chocolate-like liquid It is extremely irritating and can stimulate the surrounding peritoneum, causing severe abdominal pain. If not treated promptly, it may also cause diffuse peritonitis, which has fatal consequences.
Symptom
Symptoms of chocolate cysts Common symptoms Peritonitis infertile sexual intercourse pain dysmenorrhea
(1) Dysmenorrhea The main symptoms are secondary and exacerbated year by year, but there are also a few patients with no obvious dysmenorrhea. The ectopic endometrium is affected by ovarian hormones, and has the same periodic changes as the normal endometrium. In the second half of the menstrual period, the ectopic endometrium is highly thickened and congested, and the endometrial ectopic tumor gradually increases in pressure. When the menstrual blood accumulates in the sac, the pressure on the wall of the capsule suddenly increases and causes pain. Therefore, the characteristics of dysmenorrhea in endometriosis mostly begin before menstruation or even in the second half of the cycle, and continue throughout the menstrual period until several days after menstruation. Most of the pain is in the middle of the lower abdomen, or on one side, and the lesion is infiltrated into the uterus and rectum. Menorrhagia, menstrual blood volume, is also one of the common clinical symptoms, the general menstrual cycle is characterized by excessive menstrual blood or a long period of time.
(2) Sexual pain The uterine rectal fossa vaginal fornix, uterine ligament and other parts of the endometriosis can have sexual pain, and often more obvious before menstruation.
(3) 30-70% of infertility . Patients with endometriosis are associated with infertility. About 70-80% of patients with unexplained infertility are accompanied by endometriosis. Inflammation of the pelvic organs, obstruction of the tubal peristalsis or blockage of the fallopian tube leads to infertility, and may also be related to ovarian insufficiency, increased autoimmune response, increased prostaglandins, and increased prolactin.
(4) ovarian endometrial cyst wall is brittle and lacks elasticity, the menstrual blood gradually accumulates, the pressure inside the capsule is continuously increased, the contents can be broken from the weak part of the capsule wall, spilling into the abdominal cavity to stimulate the peritoneum, causing peritonitis, acute abdomen.
Examine
Chocolate cyst examination
Common tests include: gynecological examination, ultrasound diagnosis, MRI, CT, laparoscopy and laboratory examination.
B ultrasound image: B-ultrasound is an effective method to assist diagnosis of endometriosis. It is mainly used to observe ovarian endometriotic cysts. The sonogram is characterized by cystic mass with clear boundary or Unclear. If the adhesion around the cyst is heavy, the boundary is unclear; if the cyst has less adhesion to the uterus or surrounding tissue, the boundary is clear. The cysts are mostly medium in size, and the granular fine echoes are seen in the cysts, which is a thick expression of the cyst fluid. Sometimes due to the thickening of the old blood clots, the denser image of the thick spots appears in a mixed mass. The mass is often located on the posterior side of the uterus, and the cyst uterus is seen. When the cyst spontaneously ruptured, the sound image was recessed and the cyst was smaller than before. Laparoscopy: Laparoscopy is the new standard for the diagnosis of endometriosis. Laparoscopy can directly peep into the pelvis. When the ectopic lesion is seen, the diagnosis can be confirmed, and the clinical stage can be determined to determine the treatment plan.
Diagnosis
Diagnosis and identification of chocolate cysts
Mainly by medical history, symptoms and signs.
The diagnosis of ovarian chocolate cysts relies mainly on clinicians' understanding of these new types of acute abdomen. If the patient has a history of dysmenorrhea or a clear endometriosis, the diagnosis of the disease should be seriously considered. When the basin test is not satisfactory, the B-ultrasound can be detected by B-ultrasound examination. Posterior vaginal or abdominal puncture is helpful for diagnosis. The old menstrual blood flowing from the rupture of the chocolate cyst is diluted by the peritoneal fluid to become a thin brown liquid. If this liquid is obtained during puncture, the diagnosis is clear.
