Endometriosis and The Peritoneum

Peritoneal Retraction Pocket Defects Could Cause The Onset Of Endometriosis

The peritoneum is a thin layer of tissue that lines the abdominal cavity and surrounds and protects organs such as the uterus, ovaries, and fallopian tubes. Peritoneal retraction pockets are defective folds that form within the peritoneal structure. These pockets can form naturally in-vitro, and in most cases can cause no outward symptoms throughout a patient’s life. Conversely, they can develop as a result of surgery, injury, or infection within the abdominal cavity. 

Peritoneal retraction pocket defects can cause the onset of endometriosis because they provide a favourable environment for the growth and implantation of endometrial-like tissue. In women with peritoneal retraction pocket defects, invasive endometrial-like tissue may become trapped in these pockets, where it is afforded satisfactory space to grow and develop into lesions. In surgical settings, extensive growths are often found at the base of the excised retraction pockets, which is also seen as a marker for deep endometriosis.

Additionally, research such as Carranco et al. (2020) has exhibited that these structural alterations within the peritoneum have an association with endometriosis symptoms such as dysmenorrhea, dyspareunia, and other forms of pelvic pain. Importantly, this study impreses on the importance of retraction pockets, as they might be the only outwardly-visible indication of endometriosis within the patient.

Peritoneal retraction pocket defects may also contribute to the spread of endometriotic lesions. Endometrial tissue can migrate through the peritoneal cavity and the pockets can act as a reservoir for the tissue, allowing it to spread and develop within other parts of the abdomen.

Although the medical community currently views the development of endometriosis to be imprecise and determined by multiple factors, peritoneal retraction pocket defects stand as a strong influence on endometriotic tissue growth. Therefore, further research is vital in order to further understand the relationship between the two conditions. A richer understanding of this symbiotic dynamic could ensure that endometriosis can be more effectively diagnosed and treated in patients. Nevertheless, as we continue to refine causes and treatment pathways, retraction pockets should be removed during endometriosis excision surgery. 

Sources:

https://pubmed.ncbi.nlm.nih.gov/32474173/ 

The role of the peritoneum in the pathogenesis of endometriosis. https://academic.oup.com/humupd/article/19/5/558/614030?login=false