Tuesday, October 4, 2016

Women's Cancer - Ways To Lower Womens Cancer

Many people probably know that carrying too much weight around isn’t good for your heart, but did you know that it’s a major risk factor for women's cancer as well? Obesity is the culprit behind some 14% of cancer deaths, and more than 3% of new cancer cases, every year.

“Our No. 1 recommendation for cancer risk reduction is to stay as lean as possible within a healthy weight range. This may be one of the most important ways to prevent cancer,” says Alice Bender, MS, RD, manager of nutrition communications at the American Institute for Cancer Research (AICR).

In November 2007, the AICR put out an expert report summarizing how food, nutrition, and physical activity affect cancer and cancer prevention. Being overweight, according to the AICR report, is linked to a wide variety of cancers, including esophageal, pancreatic, gall bladder, breast, endometrial, and kidney cancers.

Fatty tissue in women who are overweight produces additional estrogen, a sex hormone which can increase the risk of uterine cancer. This risk increases with an increase in body mass index (BMI; the ratio of a person's weight and height). About 40% of cases are linked to obesity.

It seems fair and just that conscientiously working out should confer disease-fighting benefits, especially against women's cancer, and an accreting body of research suggests that under certain conditions and against certain forms of cancer, fitness may be remarkably protective. A major review article published in February on the Web site of the British Journal of Cancer synthesized the results of more than two decades’ worth of studies and concluded that the most active people are 24 percent less likely to develop uterine cancer than sedentary people are, regardless of their diets, smoking habits or body weight. Another study, this one presented in May at the annual meeting of the American College of Sports Medicine reported that women over age 30 who defined themselves as “highly competitive” by disposition and who exercised more than the average for the group had much less risk of developing breast cancer than women who worked out for less than 60 minutes per week. 


Different factors cause different types of cancer. Researchers continue to look into what factors cause this type of cancer. Although there is no proven way to completely prevent this disease, you may be able to lower your risk. Talk with your doctor for more information about your personal risk of cancer.

Research has shown that certain factors can lower the risk of uterine cancer:
  • Taking birth control pills, especially over a long period of time
  • Considering the risk of uterine cancer before starting HRT, especially estrogen replacement therapy alone. Using a combination approach to HRT may help lessen risk.
  • Maintaining a healthy weight
  • If diabetic, maintaining good disease control such as regularly monitoring blood glucose levels

Along with a healthy diet and lifestyle choices, regular exercise is one of the best things women can do to keep the risk of a first-time women's cancer or recurrence as low as it can be. This study adds to other research suggesting that regular exercise reduces breast cancer risk. Regular exercise also helps keep your physical and mental health in top shape. No matter how old you are, it’s never too late or too soon to get moving. And once you do start, keep at it!

Friday, August 19, 2016

Intramural Fibroid


What are Intramural Fibroids? 

Intramural fibroids are one of the most common types of uterine fibroids, found in 70% of women of childbearing age. Unlike subserosal fibroids, which develop on the outside covering of the uterus, and submucosal fibroids, which develop just under the lining of the uterine cavity, intramural fibroids develop within the wall of the uterus.

Intramural fibroids begin as small nodules in the muscular wall of the uterus. With time, intramural fibroids may expand inwards, causing distortion and elongation of the uterine cavity. Sometimes these fibroid tumors may grow towards the endometrial cavity to become submucosal fibroids or they may even grow towards the outer surface of the uterus to become subserosal fibroids. 

Effect of Fibroids on Reproduction

The impact of fibroid tumors on successful reproduction, have a lot to do with location. For the most part, only those fibroids that impinge upon the endometrial cavity (submucosal) affect fertility. Exceptions include large intramural fibroids that block the openings of the fallopian tubes into the uterus, and where multiple fibroids cause abnormal uterine contraction patterns. Another lesion that can cause significant problems is the one that grows off the back side of the uterus and occupies to a greater or lesser degree, the cui de sac (area behind the uterus). This location is very important in the physiology of conception, therefore it is not uncommon to see patients with these kinds of lesions present with infertility

Surgery to treat fibroids can also affect fertility in several ways. If the endometrial cavity is entered during the surgery, there is a possibility of post operative adhesion formation within the uterine cavity. This should always be checked for through the performance of a hysteroscopy or fluid ultrasound prior to beginning fertility treatment. Because myomectomy can be bloody, there is a high likelihood of abdominal adhesion formation, which could encase the ovaries, preventing the release of the eggs or block the ends of the fallopian tubes, or otherwise interfere with the normal functioning and relationships of the pelvic organs. For this reason it is important that only accomplished surgeons, who are familiar with techniques to limit blood loss and prevent adhesion foundation, perform myomectomies. In some cases multiple uterine fibroids may so deprive the endometrium of blood flow, that the delivery of estrogen to the uterine lining (endometrium) is curtailed to the point that it cannot thicken enough to support a pregnancy. This can result in early 1st trimester (prior to the 13th week of pregnancy) miscarriages. Large or multiple fibroids, by curtailing the ability of the uterus to stretch in order to accommodate the spatial needs of a rapidly growing pregnancy, may precipitate recurrent 2nd trimester (beyond the 131h week) miscarriages and/or trigger the onset of premature labor. As stated above, the location of the lesions is very important in the symptoms/impact. A lesion positioned just beneath the endometrial lining can make the structural integrity of the endometrium quite unstable and therefore, unable to develop in a progressive manner in preparation for implantation of the embryo. 

Treatment of Intramural Fibroids

If intramural fibroids aren't interfering with a woman's ability to get pregnant and aren't causing any pain, it is likely they will be left untouched. However, if the intramural fibroids are large, treatment might be necessary to reduce the symptoms produced by them.

These uterine fibroids are generally treated by means of three types of surgical procedures:

  • Removal of one or more intramural fibroids by open abdominal surgery called abdominal myomectomy.
  • Destruction of the fibroids through uterine artery embolization in which polyvinyl alcohol beads are injected into the uterine artery with a catheter to block the flow of blood to the intramural fibroids.
  • Hysterectomy which looks to remove the uterus.

At the present time, effective medicines that can permanently shrink these fibroidsare not available. Hence, surgical removal is the best option available for the treatment of intramural fibroids.

In this video, Dr. Vijayavel performed laparascopy on a patient who had large intramural fibroid [10cm by 12cm] and how he safely removed all of them.

Monday, August 1, 2016

What are Subserosal Fibroids?

Subserosal uterine fibroids develop on the outer surface of the uterus and continue to grow outwards, giving the uterus a knobby appearance. At times, these fibroids tumors may be connected to the uterus by the means of a long stalk or a stem-like base. Such stalked fibroids are called pedunculated subserosal fibroids. These fibroids are often difficult to distinguish from an ovarian mass. 

Over time, subserosal uterine fibroids may grow quite large but, unlike submucosal fibroids, which can greatly disrupt the shape of the uterine cavity as they develop beneath the uterine lining, these fibroids do not typically affect the size of the uterus’ cavity. Like intramural fibroids, which grow inside the wall of the uterus, subserosal fibroids are also quite prevalent among women in their prime reproductive age. 

What are the Symptoms of Subserosal Fibroids?

In the majority of women, subserosal fibroids produce no symptoms. Problems are customarily caused by large and pedunculated subserosal fibroids tumors. Some of the typical symptoms experienced by women with subserosal fibroids include:

  • Pelvic pain
  • Back pain
  • Constipation and bloating
  • A generalized feeling of heaviness or pressure
  • Frequent urination
  • Kidney damage due to compression of the ureter
  • Abdominal cramping and pain
  • At times, pedunculated subserosal fibroids can twist and cause pain 

As subserosal fibroids are located on the outer surface of the uterus, they typically do not affect a woman’s menstrual flow. 

In this video, Dr. Vijayavel performed laparascopy on a patient who had fibroids and how he safely removed all of them.


Monday, July 18, 2016

Women's Cancer - Uterine Cancer

The uterus is a hollow, muscular organ where a fetus grows. Uterine cancer is one type of womens cancer and can start in different parts of the uterus. Most uterine cancers start in the endometrium (the inner lining of the uterus). This is called endometrial cancer. Most endometrial cancers are adenocarcinomas (cancers that begin in cells that make mucus and other fluids).

Because endometrial cancer is often discovered at an early stage of its development in the body, most women are cured. Even if the disease is not discovered until after it has advanced, treatment is still possible but the likelihood of a long-term cure is lower. 

Uterine sarcoma is an uncommon form of uterine cancer that forms in the muscle and tissue that support the uterus.

Obesity, certain inherited conditions, and taking estrogen alone (without progesterone) can increase the risk of endometrial cancer. Radiation therapy to the pelvis can increase the risk of uterine sarcoma. Taking tamoxifen for breast cancer can increase the risk of both endometrial cancer and uterine sarcoma.

The most common sign of endometrial cancer is unusual vaginal bleeding. Endometrial cancer can usually be cured. Uterine sarcoma is harder to cure. 


If you are concerned about symptoms it is important that you see a gynaecologist (specialist doctor in women’s health). It is more likely that your symptoms are not related to cancer but it is important to have any symptoms checked.

Symptoms of endometrial cancer include:

  • bleeding after you have been through menopause (once your periods have stopped for twelve months)
  • unusually heavy periods and bleeding inbetween your periods
  • an unusual fluid or discharge from your vagina that is watery, bloody or smelly
  • pain in your belly or abdomen
  • trouble going to the toilet to pass urine (wee) or pain when you do go.

See a doctor if you have any of these symptoms and they don’t go away and/or are unusual for you. 


Treatment options include surgery, radiation therapy, and chemotherapy.

Surgery to remove the uterus (hysterectomy) may be done in women with early stage 1 cancer. The doctor may also recommend removing the tubes and ovaries.

Surgery combined with radiation therapy is another treatment option. It is often used for women with

  • Stage 1 disease that has a high chance of returning, has spread to the lymph nodes, or is a grade 2 or 3.
  • Stage 2 disease.

Chemotherapy or hormonal therapy may be considered in some cases, most often for those with stage 3 and 4 disease.

Thursday, July 14, 2016

Is Adhesion a Type of Womens Cancer?

Adhesions are bands of scar tissue that form between organs. In the abdomen, they form after an abdominal surgery or after a bout of intra-abdominal infection (ie, pelvic inflammatory disease, diverticulitis). More than 95% of patients who undergo abdominal surgery develop adhesions; these are almost inevitably part of the body’s healing process. 

Although most adhesions are asymptomatic, some can cause bowel obstructions, infertility, and chronic pain. In a study that reviewed over 18,912 patients who underwent previous open abdominal surgery, 14.3% presented with a bowel obstruction in 2 years, with 2.6% of these patients requiring adhesiolysis to relieve the bowel obstruction. Postoperative adhesions account for 74% of cases of small-bowel obstruction. Kista endometriosis is one of the most common etiologies because peritoneal lesions activate a chronic extensive inflammatory process, leading to dense adhesions. In fact, kista endometriosis-related adhesions are so common that the American Society for Reproductive Medicine (ASRM) assigns more points to adhesions for the staging of kista endometriosis than it does to the disease itself.

Laparotomy with open adhesiolysis has been the treatment of choice for acute complete bowel obstructions. Patients who have partial obstructions, with soame enteric contents traversing the obstruction, may also require surgery if nonoperative measures fail. However, operation often leads to formation of new intra-abdominal adhesions in 10-30% of patients, which may necessitate another laparotomy for recurrent bowel obstruction in the future.

Laparoscopic adhesiolysis was successfully used by Dr Vijayavel for the treatment of severe bowel obstruction in one patient with a multiple adhesive band. The patient experience painful periods and painful sex as the bowels were stuck to the uterus. Dr Vijayavel released the bowels from the uterus successfully using laparascopic adhesiolysis technique.

Compared with the open approach to adhesiolysis, the laparoscopic approach offers the following: 

  • Less postoperative pain
  • Decreased incidence of ventral hernia
  • Reduced recovery time with earlier return of bowel function
  • Shorter hospital stay

Thursday, July 7, 2016

Introduction to Pregnancy Care

Why do I need pregnancy care? 

When a woman gets pregnant, chances are she has a number of questions regarding her health from the moment she finds out she has conceived. When a woman is pregnant it is important that she is taking care of her body to the best of her ability to create the best possible environment for her baby.

Pregnancy care can help keep you and your baby healthy. Babies of mothers who do not get pregnancy care are three times more likely to have a low birth weight and five times more likely to die than those born to mothers who do get care.
Doctors can spot health problems early when they see mothers regularly. This allows doctors to treat them early. Early treatment can cure many problems and prevent others. Doctors also can talk to pregnant women about things they can do to give their unborn babies a healthy start to life. 

What is pregnancy care?

Pregnancy care is the care you receive from a health care provider, such as a doctor or midwife, during pregnancy. During pregnancy care visits, your health care provider will make sure you and the developing fetus are healthy and strong. These regular checkups are your chance to learn how to manage the discomforts of pregnancy, have any testing you may need, learn warning signs, and ask any questions you may have. 

It's best to begin before you are pregnant - this is sometimes called pre-pregnancy health or preconception planning. But if that is not possible, begin pregnancy care as soon as you know you're pregnant. 

What will happen during my first pregnancy care visit? 

The first pregnancy care visit is usually the longest. The examination is very thorough. You will be asked questions about your medical history. You will also be asked about your partner's medical history and your family's medical history. You will have a complete physical exam. Your health care provider will measure your height, weight, blood pressure, breathing, and pulse.

Usually, you will be given a gynecological exam that will include:

You may be offered blood or skin tests to check for:

Some pregnancy care doctors will also do an overall physical health check involving listening to your heart and lungs, feeling the front of your throat to see if your thyroid gland is enlarged, checking your breasts for lumps and looking at your legs to check for varicose veins.

You may also be given urine tests to check for diabetes or other infections.

Tell your doctor or nurse if you traveled to a country with Zika or think your partner has Zika. They may test you for Zika and check to see if the baby has it, too.

Your health care provider may take this opportunity to discuss your lifestyle and habits and to suggest certain changes that may help make the pregnancy healthy. One of the most important things a woman can do is to take folic acid — a B vitamin — every day to prevent serious birth defects.

You may have an earlier ultrasound if you experienced bleeding during early pregnancy, or your pregnancy may need to be 'dated', if you are unsure about when your last period was (or you didn't have a last period to speak of). Sometimes an early ultrasound is done as a genetic test, known as a nuchal translucency scan. Some pregnancy care doctors purchase ultrasound machines to perform 'informal' ultrasounds at every pregnancy visit in their private rooms (however, this is not essential and you can decline having this done if you prefer). Generally, the ultrasound your pregnancy care doctor does can only provide a limited amount of information. You would need to have an ultrasound performed by a qualified technician and reported on by a qualified ultrasonographer, to definitely confirm your pregnancy care doctor's ultrasound findings. 

Genetic testing may be offered to you (or you may request it) to screen for inherited abnormalities in your baby. There are many options to consider, with these tests usually being organised after a consultation with a genetic counsellor. This is covered in more detail in genetic testing and early ultrasound.

The main aims of the first pregnancy visit are for your pregnancy care doctor to obtain detailed information about your health, medical and pregnancy history as well as provide you with information about various aspects of the pregnancy and your care and perform (or order) some routine pregnancy tests. 

How often will I have pregnancy care visits?

If you are 18 to 35 years old and healthy, you will probably have a "low-risk" pregnancy. If so, plan to have pregnancy care visits about

  • every four or six weeks, from the first to seventh month of pregnancy (the first 28 weeks)
  • every two or three weeks in the eighth month (from week 28 to 36)
  • every week in the ninth month (from week 36 until delivery)

If you have a high-risk pregnancy, your health care provider may ask you to come in for pregnancy care more often.

Specific factors that might contribute to a high-risk pregnancy include:

  • Advanced maternal age. Pregnancy risks are higher for mothers age 35 and older.
  • Lifestyle choices. Smoking cigarettes, drinking alcohol and using illegal drugs can put a pregnancy at risk.
  • Medical history. A prior C-section, low birth weight baby or preterm birth - birth before 37 weeks of pregnancy - might increase the risk in subsequent pregnancies. Other risk factors include a family history of genetic conditions, a history of pregnancy loss or the death of a baby shortly after birth.
  • Underlying conditions. Chronic conditions - such as diabetes, high blood pressure and epilepsy - increase pregnancy risks. A blood condition, such as anemia, an infection or an underlying mental health condition also can increase pregnancy risks.
  • Pregnancy complications. Various complications that develop during pregnancy pose risks, such as problems with the uterus, cervix or placenta. Other concerns might include too much amniotic fluid (polyhydramnios) or low amniotic fluid (oligohydramnios), restricted fetal growth, or Rh (rhesus) sensitization - a potentially serious condition that can occur when your blood group is Rh negative and your baby's blood group is Rh positive.
  • Multiple pregnancy. Pregnancy risks are higher for women carrying twins or higher order multiples.

What will happen during my follow-up pregnancy care visits?

Your health care provider will check that your pregnancy is progressing well. During pregnancy care visits your provider may

  • test your urine
  • check your blood pressure
  • check your weight
  • check for swelling in the face, hands, or feet
  • examine your abdomen to check the position of the fetus
  • measure the growth of your uterus
  • listen for the sounds of the fetal heartbeat
  • offer pregnancy testing

Each visit is also an opportunity to discuss any questions or concerns that have come up since your last visit.

What is pregnancy testing? 

Your health care provider may offer you certain tests during your pregnancy. These tests are used to make sure that you are healthy and the fetus is doing well. Some tests identify possible birth defects.

The different tests are done at certain times. Your health care provider will let you know what tests you may want or need, and when you will need them.

Some common pregnancy tests for birth defects and other abnormalities include

Another common test is the biophysical profile (BPP). It is most commonly given during the third trimester. The BPP uses ultrasound combined with a fetal monitor to observe fetal heartbeat and movement. BPP allows your health care provider to evaluate the well-being of the fetus.

What is an ultrasound?

Ultrasound allows a health care provider to take pictures of the embryo or fetus as it develops. An ultrasound scan builds a picture of the embryo or fetus on a screen by bouncing sound waves into your uterus. Ultrasound is also called a sonogram. Depending on when it is done during pregnancy, it may

  • confirm your due date
  • find certain abnormalities
  • find multiple pregnancies
  • measure the length of your cervix
  • show the position and size of the fetus
  • show the position of the placenta

Ultrasound is a very safe procedure - no x-rays are involved.

Between 11 and 13 weeks of pregnancy, some providers combine a blood test with a special kind of ultrasound. Some providers refer to this as the combined test. It is used to screen for Down syndrome and other genetic birth defects. 

How ultrasound is done?

There are two ways to do an ultrasound - through the abdomen or through the vagina. Ultrasounds may be performed by your health care provider or by a trained ultrasound technician.

During an abdominal ultrasound, your provider will place the ultrasound wand on your abdomen, using a small amount of gel to help lubricate the area. You may feel pressure during the exam, but it is not painful.

During a vaginal ultrasound, your provider will insert the ultrasound wand into the vagina. This may feel similar to a vaginal exam. You may feel pressure during the exam, but it is not painful. 

What changes can I expect during pregnancy?

There are many changes that occur during pregnancy. Your body will go through a lot of hormonal changes. Your uterus will grow up to 18 times larger than it normally is. Your breasts and nipples will become larger. And you will gain weight.

You may have increased and decreased sexual desire. You may have changes in the texture of your hair and in the amount of body hair you have. And you may experience other discomforts and changes that are new to you. You can discuss these changes at your pregnancy care visits.

Common discomforts during pregnancy include

  • nausea or vomiting

    • Nosebleeds and nasal stuffiness are common during pregnancy. They are caused by the increased amount of blood in your body and hormones acting on the tissues of your nose. The hormones that seem to have the most to do with this process include the pregnancy hormone human chorionic gonadotropin (hCG), estrogen, and progesterone. Abnormal levels of thyroid hormones have also been reported in women with severe vomiting,
  • indigestion and heartburn

    • Hormones and the pressure of the growing uterus cause indigestion and heartburn. Pregnancy hormones slow down the muscles of the digestive tract. So food tends to move more slowly and digestion is sluggish. This causes many pregnant women to feel bloated. Hormones also relax the valve that separates the esophagus from the stomach. This allows food and acids to come back up from the stomach to the esophagus. The food and acid causes the burning feeling of heartburn. As your baby gets bigger, the uterus pushes on the stomach making heartburn more common in later pregnancy.
  • constipation

    • Many pregnant women complain of constipation. Signs of constipation include having hard, dry stools; fewer than three bowel movements per week; and painful bowel movements. Higher levels of hormones due to pregnancy slow down digestion and relax muscles in the bowels leaving many women constipated. Plus, the pressure of the expanding uterus on the bowels can contribute to constipation.
  • aches and pains in the abdomen and lower back

    • As your uterus expands, you may feel aches and pains in the back, abdomen, groin area, and thighs. Many women also have backaches and aching near the pelvic bone due the pressure of the baby's head, increased weight, and loosening joints. Some pregnant women complain of pain that runs from the lower back, down the back of one leg, to the knee or foot. This is called sciatica (SYE-AT-ick-uh). It is thought to occur when the uterus puts pressure on the sciatic nerve.
  • tiredness

    • During your pregnancy, you might feel tired even after you've had a lot of sleep. Many women find they're exhausted in the first trimester. Don't worry, this is normal! This is your body's way of telling you that you need more rest. In the second trimester, tiredness is usually replaced with a feeling of well being and energy. But in the third trimester, exhaustion often sets in again. As you get larger, sleeping may become more difficult. The baby's movements, bathroom runs, and an increase in the body's metabolism might interrupt or disturb your sleep. Leg cramping can also interfere with a good night's sleep.

Tips for avoiding nausea and vomiting

  • Eat a small portion of something before getting out of bed.
  • Drink small cups of ginger or peppermint tea.
  • Have several small meals throughout the day instead of fewer large ones.
  • Drink fluids between meals rather than with your meals.
  • Avoid strong spices and odors and greasy foods.

Tips for avoiding heartburn

  • Have several small meals throughout the day instead of fewer large ones.
  • Chew your food slowly.
  • Don't lie down for at least an hour after eating.
  • Wear clothes that are loose around your waist.
  • Raise your head with several pillows while sleeping.

Tips for avoiding constipation

  • Increase the amount of liquids and fiber in your diet.
  • Eat more dried or raw fruits and vegetables.
  • Use whole-grain bread and cereals.
  • Get exercise.

Saturday, June 25, 2016

Rupture in Large Kista Endometriosis Cyst

Rupture of the endometriotic cysts can occur any time of the cycle during the menstrual flow. Kista endometriosis is a common disease in women, the incidence varying from 10 to 50 percent in different parts of the world. Acute abdomen pain results from rupture of ovarian kista endometriosis cysts. Other symptoms are fever, vaginal bleeding. The pain was sudden, severe and continuous.

Cases of acute ovarian kista endometriosis cyst rupture are rare, but they may be associated with severe peritonitis and systemic disturbance, followed by adhesion formation. A theory on the formation of ascites in endometriosis was postulated by Bernstein, who suggested that the blood and endometrial cells shed into the peritoneal cavity may irritate and stimulate the peritoneum, thereby resulting in ascites. Other authors have reported that rupture of endometriotic cysts with subsequent peritoneal irritation and the production of reactive exudates may provide an explanation. Ruptured endometriotic cysts sometimes present a diagnostic problem and surgical challenge because patients with a ruptured cyst present with symptoms of an acute abdomen associated with severe abdominal pain and unstable vital signs. Ruptured ovarian endometriotic cysts can sometimes mimic ovarian malignancy because of the extremely elevated serum CA 125 concentration.

Emergency surgical intervention may lead to a better prognosis, particularly in patients without a history of previous endometrioma surgery.

In patients with ruptured kista endometriosis cysts, the ascites is usually confined to the pelvic cavity with a loculated contour, and this suggests associated pelvic adhesion, which is an extremely common and important complication of endometriosis. After a corpus luteal cyst ruptures, hemoperitoneum will be present within the pelvis and possibly throughout the abdomen. Higher attenuation blood is typically present within the pelvis, as compared with being present the abdomen, and blood may be present adjacent to the cystic lesion, indicating that the source of the hemoperitoneum is cyst rupture.

A Corpus luteum cyst is a type of ovarian cyst which may rupture about the time of menstruation, and take up to three months to disappear entirely. A corpus luteum cyst rarely occurs at age 50+, because eggs are no longer being produced in menopausal women. Corpus luteum cysts may contain blood and other fluids. The physical shape of a corpus luteum cyst may appear as an enlargement of the ovary itself, rather than a distinct mass -like growth on the surface of the ovary.

The CT appearance of ruptured endometriotic cysts is relatively distinctive compared to that of ruptured functional cysts, and the accurate preoperative characterization of ovarian cyst via CT will help the surgical planning. In conclusion, the diagnosis of ruptured endometriotic cyst should be suspected for a woman in whom CT reveals the presence of multilocular or bilateral ovarian cysts with a thick wall and loculated ascites confined to pelvic cavity with pelvic fat infiltrations.

This video shows how Dr Vijay removes a ruptured kista endometriosis cyst using laparascopy.