Chocolate cyst is a condition that is commonly found in women of reproductive age. The symptoms of suspected chocolate cyst is nonspecific, in that they may be found in other conditions also. Usually, there will be chronic abdominal pain during menstruation and this will become more painful every month. It will hurt towards the front, from the navel to the pelvis, and towards the back, from the waist to the coccyx, and might even become painful to the point of fainting. They might experience irritable bowels, flatulence, diarrhea, pain when excreting, and also pain in the stomach, back, legs or during sexual intercourse. They may discharge or urinate blood, or urinate more often. This condition can even lead to infertility because the fallopian tubes become constricted. In many cases, the build up of endometrium causes the fallopian tubes to malfunction.
Many people are not able to distinguish between the abdominal pains associated with menstrual cramps and those caused by a chocolate cyst. Let’s try to analyze this ourselves. This condition normally occurs in women between the ages of 20 and 40 years old. If you are around that age and haven’t experienced this level of pain during menstruation before and the abdominal
Chocolate cyst in medical terms is known as endometriosis. If we compare the uterus to a rose apple, the endometrium (uterus lining) is the soft flesh on the inside of the apple; the pulp and fiber. When a woman menstruates, this thin coating will peel off and combine with the menstrual blood that discharges from the vagina. However, some of the blood that does not escape, but flows back down the fallopian tubes, will become embedded on the endometrium. The endometrial cells are like seeds, and will slowly get bigger and grow into cysts. Whatever part they become embedded on, the cysts will grow there; such as on the pelvic floor, fallopian tubes, intestines, vagina, uterus, and so on. The most common place for a cyst to grow is on the ovaries. This is because they have the largest amount of estrogen hormone, providing ideal conditions for growth. When a woman menstruates, the endometrium will always peel off and will release blood, but once the endometrium gets to the ovaries and releases blood, there is no place for it to go. This causes a gradual accumulation of blood, and like a balloon that is slowly being filled with water, the cyst is slowing filling with blood. If the blood is in the cyst for a long time, it will appear brown and resemble chocolate, hence the name, ‘chocolate cyst’. If the pain gradually gets more severe every month, preventing you from going to work, then you should suspect that you may have a chocolate cyst. The best thing to do is see a doctor as soon as possible, in order to get a checkup. If it is found that you have a chocolate cyst, the best option is to get early treatment. In cases where the symptoms aren’t too severe, the doctor might ask the patient to monitor themselves and come back for regular checkups. In cases where the symptoms are more severe, the doctor might treat a chocolate cyst using medication, or if the patient is already taking medication and it has not been effective, then might decide on surgery. Nowadays, doctors choose laparoscopic surgery as it is a standard procedure, utilizing modern equipment. It is a form of minimally invasive surgery, or MIS, and is a surgical technique that is highly efficient. The patient will only have a small surgical incision, experience minimal pain and have a short recovery time. That isn’t scary at all!
At Samitivej, the laparoscopic operating rooms have built in 3D-4K technology, maximizing precision and increasing safety. What is 3D-4K? The extra resolution of 4K medical monitors (four times the resolution of full HD) and 3D imaging, means a clearer view of fine detail and greater depth perception; providing a more realistic visualization of complex surgical procedures. It also allows zooming in without pixelation, for a magnified view.
Faculty of Medicine Siriraj Hospital, Mahidol University , 1999