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Endometriosis, Emergency Medicine

Francis L. Counselman Reviewed 06/2017
 


Basics

Description

  • Presence of endometrial tissue and glands outside uterus

  • An estrogen-dependent chronic inflammatory disease

  • Affects 6–10% of women of reproductive age and 50–60% of women/teenage girls...

Diagnosis

Signs and Symptoms

History

  • Dysmenorrhea (50–90%)

  • Deep pelvic pain

  • Dyspareunia

  • Dysfunctional uterine bleeding

  • Lower abdominal pain

  • Nausea, abdominal distention

  • Infertility (30–50%)

Physical Exam

  • Focal ...

Treatment

Pre-Hospital

  • Stabilize as needed.

  • Pain control as necessary

Initial Stabilization/Therapy

  • Treat hypotension or tachycardia from blood loss with isotonic IV fluids

  • May need to transfuse packed red...

Follow-Up

Disposition

Admission Criteria

  • Intractable pain

  • Significant bleeding

  • Unclear diagnosis

  • Need for further workup and treatment

  • Peritoneal signs

Discharge Criteria

Most patients with suspected endometr...

Pearls and Pitfalls

  • Occurs in 6–10% of women of reproductive age

  • Endometriosis frequently causes cyclical pelvic pain

  • Rarely diagnosed initially in ED; delay between symptom onset and diagnosis frequent...

Additional Reading

  • Cirilli  AR, Cipot  SJ. Emergency evaluation and management of vaginal bleeding in the nonpregnant patient. Emerg Med Clin North Am.  2012;30:991–1006.

  • Giudice  LC. Clinical pra...

Codes

ICD9

  • 617.1 Endometriosis of ovary

  • 617.3 Endometriosis of pelvic peritoneum

  • 617.9 Endometriosis, site unspecified

  • 617.0 Endometriosis of uterus

  • 617.2 Endometriosis of fallopian tube

  • 617.4 Endometriosis...

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