Endometriosis Image Library 

The most comprehensive image library ever published was by Drs Dan Martin, David Redwine, Harry Reich, and Arnold Kresch in their Color Atlas of Endometriosis, which also provides a guiding lecture set.

In addition to this we are able to provide images, supplied by physicians around the world, which provide references to different presentations of endometriosis. If you have an image you would like included in the image library please email images@endozone.org for review by our Editorial Board.

Adhesiolysis & Excision of Endometriosis using the Everest Medical® BiLAP® Bipolar Probe by Dr Mark Perloe (contains two downloadable videos)

Laparoscopic appearance of the fallopian tube adhesion. In the first screen, the tip of the manipulating probe is to the right and the fallopian tube, slightly out of the focus is in the middle. In the subsequent frames, the fallopian tube adhesion becomes apparent as it is pulled away with the manipulating probe. The uterus appears at the top of the screen. The video segment is ended with the stretched appearance of the fallopian tube adhesion. (May also be viewed as a Quicktime movie: 560 Kb)

Adenomyosis (Endometriosis interna): Endometrial glands and stroma extend through the myometrial muscle fibers well below the endometrial-myometrial junction.

It has been associated with an enlarged, globular uterus with hypertrophied uterine walls, although the uterus may be grossly normal in some cases. Occasionally, 2 - 5 mm cysts containing red-brown material can be seen grossly in the myometrium. This reflects the cyclic bleeding of the entrapped endometrium in response to ovarian hormone levels during the menstrual cycle. Image 1 and Image 2. 

Photo by Oleg Bess, M.D. Scarlike endometriosis: a less common and a less noticeable type of endo

The circled area contains both black endometrial implants (left side) and white scarred implants (right side). The entire area is hormonally active and should be excised. This area overlies the right side of the pelvis beneath the right ovary. white implants of Endo. Image courtesy of http://www.womenssurgerygroup.com.

This photograph demonstrates implants of endometriosis with both black and white appearances. These implants are overlying the bladder. image. Image courtesy of http://www.womenssurgerygroup.com.

Endometriosis may have many appearances. This photo includes white endometriosis, clear endometriosis, red endometriosis and powder burn lesions. Image courtesy of Atlanta Reproductive Health Centre by Mark Perloe, MD

Female Genital Pathology - Upon closer view, these five small areas of endometriosis have a reddish-brown to bluish appearance. Typical locations for endometriosis may include: ovaries, uterine ligaments, rectovaginal septum, pelvic peritoneum, and laparotomy scars. Endometriosis may even be found at more distant locations such as appendix and vagina.

Bowel Endometriosis: note the blister-like appearance of the lesion in the top left corner. Image courtesy of http://hometown.aol.com/MAndre2517/lap.html 

View of cervix via speculum, showing endometriosis. Endometriosis, the presence of ectopic endometrial tissue outside of the uterus, can occur in many different locations.
Source: Gynecology Case Challenge: Progressive Pelvic Pain in a Young Nulliparous Female [Medscape Women's Health 2(6), 1996. © 1996 Medscape, Inc.]

This 25-year-old patient had a history of heavy periods with anaemia (8 g Hb). Over the past 2 years, she has had a D&C, a hysteroscopy and a colposcopy without diagnosis. She took oral contraceptives but no improvement was seen. Finally, at the last consultation, during menorrhagia, the diagnosis of endometriosis was made and this picture was taken. Dr C Crescini, Italy

Deep and superficial endometriosis of the cul-de-sac - This is a photo taken during laparoscopic surgery of multiple endometriosis implants. The uterus is at the top of the photo (you can only see the bottom part of the uterus here). There are many dark red endometriosis implants on the "cul-de-sac," which is the area below the uterus. This area corresponds to the top of the vagina, so that if one were to put a needle through the top of the vagina, it would come out right in the center of this photo. This is the area where the penis pushes against during intercourse, so, not surprisingly, this patient complained of painful intercourse. These implants were completely removed using laparoscopic scissors.

Female Genital Pathology - Grossly, in areas of endometriosis the blood is darker and gives the small foci of endometriosis the gross appearance of "powder burns". Small foci are seen here just under the serosa of the posterior uterus in the pouch of Douglas. Such areas of endometriosis can be seen and obliterated by cauterization via laparoscopy.

This patient demonstrates endometriosis in the 'cul-de-sac' (the area behind the uterus and in front of the rectum). She presented with painful intercourse and diarrhoea associated with her menstrual periods. Image courtesy of Atlanta Reproductive Health Centre by Mark Perloe, MD

Dissection of the space between the rectum and vagina allows removal of deep endometriosis in patients with severe pain. If pre-operative testing reveals narrowing of the bowel, then a laparoscopic bowel resection can be performed. It is important that a thorough cleansing of the bowel be carried out before any surgery for pelvic pain where endometriosis is suspected. Failing to prepare the bowel pre-operatively may result in increased risk and limit the surgeons ability to perform a satisfactory resection. Image courtesy of Atlanta Reproductive Health Centre by Mark Perloe, MD

• "Chocolate" liquid spilling
• Close-up of nodule
• Excision of the nodule is starting
• Nodule during excision with a monopolar needle
• Endometriosis nodule on the left salpinx. Many inflammatory pseudocysts are clearly visible
• Pre and postoperative views of Endo nodules

Female Genital Pathology - This is a section through an enlarnged 12 cm ovary to demonstrate a cystic cavity filled with old blood typical for endometriosis with formation of an endometriotic, or "chocolate", cyst. The hemorrhage from endometriosis into the ovary may give rise to a large "chocolate cyst" so named because the old blood in the cystic space formed by the hemorrhage is broken down to produce much hemosiderin and a brown to black color.

From: Cliniweb International
(c) 1995-1999 Oregon Health Sciences University
MeSH (c) 1997 National Library of Medicine

Diffuse bleeding often occurs in endometriotic tissue. In addition, blood sometimes collects in cyst-like cavities. However, the walls of such cavities are never covered with endometriotic tissue like they are in endometriomas.

Ruptured Endometriosis Cyst - This is a photo taken during laparoscopy of an endometriosis cyst. These cysts are called "endometriomas" and develop as endometriosis implants slowly bleed into the ovary over many months. This patient complained of worsening left-sided pain, and was found to have a small rupture. There was a small amount of blood in her abdomen. The cyst was removed and the normal ovarian tissue was saved.

A 'chocolate cyst' (endometrioma) is formed when endometriosis invades the ovary. A dark, thick fluid fills these ovarian cysts. They are best treated by removal of the cyst and may recur if simply drained or when the inner wall cannot be removed and is burned with a laser. Image courtesy of Atlanta Reproductive Health Centre by Mark Perloe, MD

Endometriosis may have many appearances. This photo includes white endometriosis, clear endometriosis, red endometriosis and powder burn lesions. Image courtesy of Atlanta Reproductive Health Centre by Mark Perloe, MD 

Endometriotic deposits on right diaphragm International Society for Gynecologic Endoscopy

Endometriosis involving appendix International Society for Gynecologic Endoscopy

Fallopian Tube Endometriosis. © 1997-99 Tulane Medical Center Female Reproductive Pathology Laboratory (Nina Dhurandhar, MD and William H. Robichaux, MD)

Endometriosis may have many appearances. This photo includes white endometriosis, clear endometriosis, red endometriosis and powder burn lesions. Image courtesy of Atlanta Reproductive Health Centre by Mark Perloe, MD

Ovarian Endometriosis #1 and #2: note the red, flame-like implants on these photos of the right ovary. Menoi Andre

Images from the homepages of the Endometriosis Association NSW, Inc.:

• Endometriosis overlying the left ureter.
• Endometriosis completely filling the pelvis. The bowel is stuck to the back of the uterus.
• A deposit of endometriosis involving the rectum.

The EANSW, Inc. is an organization dedicated to providing relevant and current information about endometriosis, offering mutual support and help to sufferers, facilitating access to treatment by a wide range of health practitioners with interest and expertise in the management of this disease, promoting public awareness of endometriosis and conducting and supporting research. The EANSW, Inc. may be found online at www.pta.net.au/endo. all images (c) copyright EANSW, Inc.

Images Excerpted From: "A Review of Endometriosis" by: Danny Tucker, MRCOG, Women's Health UK, 2000 (Reprinted from www.womens-health.co.uk). 

• The small black spots are Endometriosis on the peritoneum.
• Laparoscopic view of an endometrioma of the left ovary.  Note the 'chocolate' blood coming from where it has burst.

Images from EndoRama: all images copyright by Michelle W.

• Pathology: The uterus with cervix, the Fallopian tube and ovary.

• A view upwards towards the liver (indicated by the arrows). The liver is actually fairly close to the endometriosis "action".

• The bulging dark spot near the middle of the picture is an endometrioma.

• Although it's tricky to see, the surgeon checked out the appendix, which was hidden in back of the ovary. The Fallopian tube is being lifted. The shiny red sphere on the left is the ovary.

• A pseudopocket that was discovered during the laparoscopy. The body had produced a kangaroo-like sac that held endometriosis. Once the pocket was discovered, the endo was removed. The blood you are seeing in the pocket is just the result of the surgery.

• Arrows pointing to dark spots of endometriosis implants.

all images © by St. Charles Medical Center
2500 NE Neff Road
Bend, Oregon 97701

• Subtle as well as typical endometriosis is seen in this view of the cul de sac and uterosacral ligaments
• The scissors tip is resting against the top edge of a nodule of endometriosis of the right uterosacral ligament
• A yellowish plaque of endometriosis (arrow) is seen directly over the ureter
• The peritoneum next to the lesion has been opened and is being lifted up and away from the ureter (U). This allows the peritoneum containing the endometriosis to be completely removed without damage to the ureter
• This is obliteration of the cul de sac seen in a patient with Stage 4 endometriosis
• This is a cross section of a rectal nodule of endometriosis invading the wall of the colon

Histopathology of resected ureteral segment reveals fibrosis and extrinsic endometriosis.
Source: [Medscape Women's Health 2(6), 1996. © 1996 Medscape, Inc.]

Endometriosis, histology. © 1999 The University of Kansas Medical Center

Laparoscopic view of intestinal endometriosis. In this video segment, the reddish-brown endometriotic foci are seen on the serosal surface of the large bowel. Towards the end of the video segment, one central focus of endometriosis is vaporized by the CO2 laser beam. (May also be viewed as a Quicktime movie:1.06 Mb)

Ovarian endometriosis with endometriotic adhesions between ovary and sigmoid colon International Society for Gynecologic Endoscopy

"The role of laparoscopy in the diagnosis of gynecologic pathologies" by A. Babaknia, MD, of the Women's Health Institute of California

"The role of laparoscopy in the treatment of gynecologic pathologies" by A. Babaknia, MD, of the Women's Health Institute of California

Andrew Cook, MD, of the Omega Institute of Health has excellent presentations of red, white, black and blue lesions, as well as bowel and diaphragmatic Endometriosis on his website.

Dr. Cook also provides viewers with video clips portraying an excision of peritoneum containing endometriosis, unipolar coagulation, and a CO2 vaporization of peritoneum containing endometriosis.

Contents Copyright © 1999 by Medical Web Resources, LLC

• Small spot of Endo on the Lt. ovary
• Extensive damage from endometriosis. 

© 1998-99 Phegan, Thong & Associates Pty Ltd

Endometriosis, left ovary

Laparoscopic view of ovarian endometriosis. In this video segment, initially, the normal surface of the ovary is visualized. The ovary is moved by the manipulating probe to view the posterior aspect of the ovary to reveal the reddish-brownish foci of endometriosis on the ovarian surface. (May also be viewed as a Quicktime movie:1.01 Mb)

• Ovary Containing Endometrioma Cyst
• Close-Up of Cyst and Normal Ovary
• Endometriosis Cyst and Normal Ovary
• Endometriosis of the ovary and peritoneum
• Endometriosis on the pelvic side wall
• Endometriosis implants in one cm. diameter
• 2 close-ups of Endometriosis implants in a young, infertile woman behind the uterus and ovaries

Ovarian endometriosis International Society for Gynecologic Endoscopy

A panoramic view of the pelvis at the end of excision

Clear implants of endometriosis have the appearance of drops of water resting on the surface of the pelvic organs. These lesions may also have a slightly red or brown pigmentation. The endometriosis implants in this photograph are located in the deep cul-de-sac behind the uterus. peritoneal pockets that usually contain Endo

Photo of peritoneal endometriosis - This is a photo of "tobacco stain" endometriosis. These implants are light brown and rather flat in appearance. They are "stuck" to the peritoneum, which is the shiny, smooth lining on the inside of our bodies. These implants were found on the side of the pelvis, near the ovaries. The area of this photo is about 2 inches by 2 inches in real life. These implants were removed using laparoscopic scissors.

Resection of the uterosacral ligaments and peritoneal surface endometriosis resulted in relief of pain for this patient. But, endometriosis frequently recurs. Therefore, I recommend hormonal suppression for those patients not trying to get pregnant immediately. Image courtesy of Atlanta Reproductive Health Centre by Mark Perloe, MD

Endometriosis, lungs, pleura, lymph nodes (rare).  Image 1 and Image 2.

Endometriosis on the left sacrouterine ligament. The rectum is clearly visible at the bottom

Endometriosis over left uterosacral ligament International Society for Gynecologic Endoscopy

The most common site for endometriosis is on the uterosacral ligaments behind the uterine cervix. This patient, who presented with pelvic pain, had involvement extending deep into the space between the vagina and the rectum. Image courtesy of Atlanta Reproductive Health Centre by Mark Perloe, MD  

In this patient, endometriosis is seen on the posterior surface of the uterine fundus (just to the right of the metal probe), at the base of the right uterosacral ligament and in the cul-de-sac between the uterine ligaments. Image courtesy of Atlanta Reproductive Health Centre by Mark Perloe, MD

Resection of the uterosacral ligaments and peritoneal surface endometriosis resulted in relief of pain for this patient. But, endometriosis frequently recurs. Therefore, I recommend hormonal suppression for those patients not trying to get pregnant immediately. Image courtesy of Atlanta Reproductive Health Centre by Mark Perloe, MD

Patients with severe menstrual cramps who do not have endometriosis may also benefit from cutting the nerve fibres that run in the uterosacral ligaments behind the uterus. About 60-80% receive some degree of pain relief with this procedure. Image courtesy of Atlanta Reproductive Health Centre by Mark Perloe, MD

The left salpinx after excision of superficial endometriosis

black powderburn implants

Endometriosis may have many appearances. This photo includes white endometriosis, clear endometriosis, red endometriosis and powder burn lesions. Image courtesy of Atlanta Reproductive Health Centre by Mark Perloe, MD

Praxis Dr. med. Pierre E. Villars of Facharzt FMH für Gynäkologie und Geburtshilfe, Zürich, Switzerland has provided the Endometriosis Zone with ultrasound photos and corresponding operation views of Endometriosis.

• Endometriosis, left ovary.
• Endometriosis, lungs, pleura, lymph nodes (rare).  Image 1 and Image 2.
• Adenomyosis (Endometriosis interna): Endometrial glands and stroma extend through the myometrial muscle fibers well below the endometrial-myometrial junction.
• It has been associated with an enlarged, globular uterus with hypertrophied uterine walls, although the uterus may be grossly normal in some cases. Occasionally, 2 - 5 mm cysts containing red-brown material can be seen grossly in the myometrium. This reflects the cyclic bleeding of the entrapped endometrium in response to ovarian hormone levels during the menstrual cycle. Image 1 and Image 2.

Endometriotic deposits on uterovesicle fold International Society for Gynecologic Endoscopy

The cervix: the cervix is not completely normal for A nulliparous woman. The external orifice is open and the anterior wall of the cervical canal can be seen. At h.3 there is a small blue spot. Blood is present in the vagina and hides the posterior fornix. Image Dr C Crescini, Italy

Posterior fornix of the vagina: the upper part of the picture shows the cervix; lower down the posterior fornix can be seen and under the blood the red and blue endometriotic nodules are visible. Image Dr C Crescini, Italy

As above, increased magnification. Image Dr C Crescini, Italy