Reason: endometriosis, adhesions, bowel lesions noted on laparoscopy History: pelvic pain, dysmenorrhea.Additional history per electronic medical record: On laparoscopy, multiple areas of endometriosis, both classic black powder burn and clear lesions noted. Approximately 4 cm adhesion of bowel and omentum to the right abdominal wall. The right ovary was noted to have an endometrioma. PELVIS:UTERUS, ADNEXA: In the region of the right adnexa, there is a rounded structure which appears to arise from the right ovary which measures 2.0 x 2.3 cm (series 501, image 35) which demonstrates intrinsically increased T1 signal with associated T2 shading and is compatible with an endometrioma or hemorrhagic cyst. The remaining portions of the right ovary demonstrate normal-appearing follicles. There are multiple additional round structures within the left adnexa which demonstrates intermediate T2 signal and possible fluid fluid levels which are compatible with additional hemorrhagic cysts and/or endometriomas. In total, the right adnexa measures approximately 2.2 x 3.3 cm. The left adnexa measures approximately 2.5 x 4.5 cm.The uterus is retroverted and anteflexed in position and measures approximately 5.8 x 4.5 x 7.8 cm. Several round foci of decreased T2 signal within the myometrium are compatible with fibroids. There is no specific evidence of adenomyosis. Normal variant nabothian cysts are noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: A loop of small bowel is present immediately adjacent to the right adnexa with possible slight bowel thickening and which may be adherent to the right adnexa. No evidence of obstruction currently within the partially visualized portions of bowel.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
Multiple adnexal structures as described above which may reflect endometriomas and/or hemorrhagic cysts. Recommend correlation with prior ultrasound and/or subsequent ultrasound in 4-6 weeks, as persistence would favor endometriomas. No large/visible bowel implants are identified. Possible bowel adhesion to the right adnexa.