Pancreatic endometriosis is a condition where tissue resembling the lining of the uterus, or the endometrium grows in and around the pancreas. It can occur with or without classical endometriosis.
About the pancreas
The pancreas is an organ that sits in the abdomen. Its role is to produce digestive enzymes and hormones that regulate blood sugar. Other organs such as the stomach, small intestine, liver, spleen, and gallbladder surround it.
How does endometriosis affect the pancreas?
Endometriosis occurs when tissue resembling the endometrium grows outside the uterus and forms cysts. It usually occurs in and around pelvic organs close to the uterus. These include the ovaries and the fallopian tubes (the tubes connecting the ovaries to the uterus). However, in rare cases, endometriosis can also occur in other organs and tissues such as the kidneys, appendix, pancreas, and even lungs.
In pancreatic endometriosis, the extrauterine tissue can lead to pancreatitis or the inflammation of the pancreas. It can also form cysts that may bleed, usually in synchrony with the menstrual cycle, and cause pain or disrupt the function of the pancreas. Sometimes, scar tissue can form around the cysts and further disrupt the function of the pancreas.
How common is pancreatic endometriosis?
Pancreatic endometriosis is very rare with only a few cases in the literature. A group of researchers at The Mount Sinai School of Medicine in New York reported the first cases in 1984.
The condition has been reported in women ages, 21 to 68 who were still menstruating or in menopause.
Causes of pancreatic endometriosis
Like classical endometriosis, the cause of pancreatic endometriosis is not clear. Some researchers think that retrograde menstruation may cause the condition. This is the back-flow of menstrual blood up the fallopian tubes carrying stem cells from inside the uterus to the pancreas, where they implant and form endometrial lesions.
Symptoms of pancreatic endometriosis
Symptoms of pancreatic endometriosis include:
- abdominal pain that usually coincides with the menstrual cycle
- digestive problems including vomiting and diarrhea
- nausea and weight loss
Diagnosis of pancreatic endometriosis
Pancreatic endometriosis is difficult to diagnose as it is so rare. Imaging tests and needle-guided biopsy can help diagnose the condition. The patient’s previous medical history such as the presence of classical endometriosis or pancreatitis can also be useful in reaching a diagnosis.
Imaging tests to diagnose pancreatic endometriosis
Ultrasound uses high-frequency sound waves to produce an image of the internal organs.
MRI is a non-invasive technique in which detailed three-dimensional images of internal organs are produced using strong magnets.
CT uses X-ray images taken from different angles. It then combines them with the aid of a computer to create detailed images of internal organs as well as bones and blood vessels.
None of these imaging techniques is sensitive enough to detect all endometrial lesions. They can also not differentiate between endometrial cysts and cancerous ones.
A pancreatic tissue biopsy obtained from around the lesions and observed under the microscope can help identify the nature of the lesions. However, this is a more invasive approach compared to imaging techniques.
The pain caused by the disease can be managed with non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen, or opioid narcotics in cases of severe pain. It is important to remember that opioids are highly addictive and should only be used if prescribed by a healthcare professional and not for extended periods of time.
Other medications that can alleviate the pain caused by pancreatic endometriosis include hormonal treatments like gonadotrophin-releasing hormone (GnRH) receptor agonists and antagonists and hormonal contraceptives.
The surest method of treating endometriosis of the pancreas is to remove the affected and surrounding tissues with excision surgery.
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