Links to a low resolution PDF version of the Laparoscopic Appearance of Endometriosis Color Atlas is at Color Atlas LAE 1990.

Higher resolution pages are on the links below.

Page 21.  Endometriosis and red adhesions cover the posterior left broad ligament. Black areas of endometriosis are noted to the left. Hemorrhagic adhesions are noted in the center. These adhesions can hide endometriosis.

The biopsy shows endometriosis infiltrating through the entire hemorrhagic adherent area of the broad ligament.

Page 22.  The brown appearance of this right uterosacral ligament may be related to the positive chlamydia culture from this surface. Patients with endometriosis can also have chlamydia.

The biopsy shows that this lesion goes deeper than is apparent and is almost to the level of the recto-sigmoid colon and the vaginal apex. The lesion was measured to a depth of 7 mm toward both the rectum and vagina. Bipolar, thermal and laser coagulation are inadequate to coagulate this depth. Destruction of this lesion requires vaporization or excision.

Page 23.  Diffuse endometriosis is seen in the cul-de-sac. However, the fibrotic lesion at the center was palpated on bimanual exam as a 2 cm nodule. The lesion extended from the peritoneum to the vagina and is seen in the posterior vaginal fornix.

The laparoscopic dissection was taken to the level of the vagina. A probe in both the vagina and the rectum was used for recognition of these areas. An incision was made directly onto a wet backstop sponge in the vagina. The lesion was pulled through the vagina after mobilization. The biopsy shows endometriosis infiltrating through the fibromuscular scar.

Page 24.  What appears to be a small lesion on the sigmoid colon often represents the "tip of the iceberg". These can be easy to palpate but hard to see.

The biopsy shows that the red area at the top of the bowel is an edematous vascular area of glands and stroma. The muscular infiltration can be seen beneath this. The infiltration extended through 80% of the muscle wall.

Page 25.  Chocolate cysts are commonly endometriosis or corpus lutea (ovulatory cyst).  On opening a chocolate cyst, the appearance may be one of irregular brown and red areas on a white pseudocapsule. Other endometriomas have diffuse areas of red patches with no obvious hemosiderin.

The biopsy shows  hemosiderin laden macrophages in the brown area. A polypoid area of glands and stroma is seen in the red areas immediately adjacent to the hemosiderin.