They are best treated by removal of the cyst and may recur if simply drained or when the inner wall cannot be removed and is burned with a laser. The most common site for endometriosis is on the uterosacral ligaments behind the uterine cervix. This patient who presented with pelvic pain had involvement extending deep into the space between the vagina and the rectum. Endometriosis may have many appearances. This photo includes white endometriosis, clear endometriosis, red endometriosis and powder burn lesions.
Powder burns on the right uterosacral ligament causing painful intercourse.
Dissection of the space between the rectum and vagina allows removal of deep endometriosis in patients with severe pain. If preoperative testing reveals narrowing of the bowel, then a laparoscopic bowel resection can be performed. It is important that a thorough cleansing of the bowel be carried out before any surgery for pelvic pain where endometriosis is suspected. Failing to prepare the bowel preoperatively may result in increased risk and limit the surgeons ability to perform a satisfactory resection. Resection of the uterosacral ligaments and peritoneal surface endometriosis resulted in relief of pain for this patient.