At ESSE Care, we frequently meet patients struggling with endometriomas—a type of ovarian cyst filled with old blood, often called a “chocolate cyst.” Endometriomas can be particularly complex, especially when misinformation leads patients to underestimate the severity of their condition. In this blog, Dr. Karli Provost Goldstein, a minimally invasive gynecologic surgeon at ESSE Care, shares insights from two recent surgical cases that highlight the challenges of treating endometriomas and the importance of timely, specialized care.
Let’s take a closer look at these cases and what they reveal about managing endometriomas effectively.
Endometrioma Myths: Yes, They Can Rupture
One of the most common misconceptions surrounding endometriomas is the belief that they don’t rupture. This myth can mislead patients into delaying care, potentially allowing their condition to worsen. In a recent surgery, Dr. Goldstein treated a patient who had been incorrectly informed that her endometrioma was only 3–4 cm. However, by the time she came to surgery, the cyst had grown to 6.5 cm and had already ruptured, leaking its contents into surrounding tissues.
In the video, Dr. Goldstein explains the significant surgical challenges posed by the ruptured cyst. The leaked contents had adhered to crucial pelvic structures like the bowel, ureter, and uterosacral ligament, making the dissection delicate and complex. What was once thought to be a small cyst had become a major issue, requiring expert surgical intervention to safely remove the endometrioma and free the adhered organs.
Key Takeaway: Endometriomas can rupture, and when they do, the leaked fluid can cause serious complications by adhering to nearby organs. It’s essential to have accurate diagnoses and timely surgical intervention to avoid worsening the situation.
Cyst Splatter and Adhesions: Why Timing is Everything
Another aspect of endometrioma surgery that patients often don’t realize is the risk of cyst splatter. When an endometrioma ruptures, the contents can “splatter” into surrounding areas, causing new endometriosis lesions to form. This was the case in another surgery Dr. Goldstein performed, where ruptured cyst material had led to widespread adhesions involving the bladder, bowel, uterus, and ovaries.
In this video, Dr. Goldstein discusses the adhesions and nodular lesions found during the surgery. These adhesions had created a complex web of tissue that locked the organs in place, contributing to the patient’s chronic pain and pelvic immobility. Early surgical intervention is vital in cases like these to prevent the worsening of adhesions and the spread of endometriosis.
Key Takeaway: Once an endometrioma ruptures, the contents can spread, forming new lesions and adhesions that make future surgeries more difficult. Early, expert surgery can prevent further damage and relieve symptoms.
Why Early, Expert Surgery Matters
Both of these cases underscore one crucial point: timely intervention is key when dealing with endometriomas. Misdiagnosis or delayed care can lead to ruptures, cyst splatter, and complex adhesions, making surgery more difficult and increasing the risk of damage to important pelvic organs like the bladder or bowel.
At ESSE Care, we specialize in treating endometriosis and endometriomas using minimally invasive techniques that prioritize precision and patient safety. By addressing these issues early, we aim to minimize damage, relieve pain, and preserve the function of affected organs.
If you’re experiencing chronic pelvic pain, suspect you have endometriosis, or have been diagnosed with an endometrioma, we encourage you to seek out a specialist for a comprehensive evaluation. At ESSE Care, we’re dedicated to providing the expert care you need to feel better and protect your long-term health.
Final Thoughts
At ESSE Care, we prioritize meticulous ovarian reconstruction with suturing during endometriosis and endometrioma surgery. By carefully suturing the ovary, we can control bleeding without relying on cautery or energy sources, which risk damaging ovarian follicles and compromising ovarian reserve. This approach is essential for maintaining fertility potential and ovarian health, as cautery can harm the delicate ovarian tissue.
Restoring the ovary’s anatomy through suturing is also crucial in preventing adhesive disease. Adhesions form when tissues and organs stick together, often exacerbated by bleeding left unchecked, which acts as an adhesive. We’ve seen cases where patients had previous endometrioma surgeries without proper reconstruction, resulting in severe complications—such as the bowel adhering to the ovary—due to improper handling of endometriosis. This complex scarring increases the risk of bowel involvement and can even necessitate bowel resection, posing further risks.
Our approach is rooted in advanced surgical techniques that control bleeding, prevent adhesions, and preserve tissue health. For endometriosis patients, who are already predisposed to adhesions due to inflammation and fibrosis, precise bleeding control and anatomical restoration are critical to minimizing future complications and supporting long-term reproductive health. At ESSE Care, our commitment is to offer advanced, minimally invasive solutions that protect ovarian health and prevent unnecessary scarring and adhesions.
