"Ask Dr. Cook" is a series of questions and answers regarding endometriosis. The current subject and answer can be found on Current Ask Dr. Cook web page. The questions may represent a summary of questions I have been asked by several different patients. I hope you find this information helpful. If you have a question you would like answered, please Submit A Question.

Peritoneal Pockets

Question:
What is a peritoneal pocket and what possible effect can it have on fertility. My doctor found two of said "pockets" but saw no endometriosis.

Answer:
Peritoneal pockets should be considered endometriosis until proven otherwise. Peritoneum covers the inside of the body much like the skin covers the outside of the body. Peritoneum normally has the appearance of saran wrap. It is stretched over the organs resulting in a flat contour. Peritoneal pockets can be of varying depths, ranging from slight indentations to very deep narrow pockets.

Peritoneal pockets are also referred to as Allen Masters Syndrome. Dr. Allen and Dr. Masters published an article back in 1955 titled "Traumatic laceration of uterine support". They felt that the trauma of pregnancy caused peritoneal pockets which resulted in pain and abnormal vaginal bleeding. De Brux published a report in 1968 documenting endometriosis in half of the peritoneal pockets he studied. Dr. Donald Chatman then followed up in 1981 with a larger study which noted 68% of peritoneal pockets with endometriosis and an even larger study five years later showing endometriosis in 79% of peritoneal pockets. Thus endometriosis is associated with peritoneal pockets in the majority of cases.

In its mild form peritoneal pockets can result in minor changes in the contour of the pelvic peritoneum. On occasion this is the only appearance of endometriosis. The surgeon must have a good understanding of the normal contour of the pelvic peritoneum and a high index of suspicion that this mild variation in contour alone can truly represent endometriosis. Deep pockets can be missed if a systematic approach is not used to literally explore every nook and cranny. If a deep pocket is found the base of the pocket should be grasp with a locking instrument. This identifies the base of the pocket during the dissection process. If this is not done portions of the peritoneum can easily be lost during the dissection and removal. If some of the peritoneum lining the pocket which contains endometriosis is left behind this can result in recurrent endometriosis.

To answer your specific question, statistically, your doctor probably did see endometriosis. Since peritoneal pockets usually are endometriosis, this finding can have the same effect on fertility as endometriosis.

Updatede October 29, 2005