What are the causes of chocolate cysts? Chocolate cysts are caused by the ectopic endometrium to the ovaries and adnexa in the pelvic cavity, each time the menstrual period, the ectopic endometrial cells also bleed in small amounts, and the blood is not like the menstrual blood in the uterus, but wrapped by the peritoneum, bleeding again and wrapped again, accumulating month after month, during which part of it is also absorbed by the peritoneum, and the rest becomes a kind of old accumulation of blood, the color of chocolate like coffee, hence the name chocolate cyst. This is why the name chocolate cyst was given to it. In recent years, the incidence of endometriosis has been increasing year by year for various reasons, and the incidence of chocolate cysts has also been increasing. The disease is a worldwide problem that cannot be cured yet, but there are still more measures to control the symptoms and eliminate the cysts, and the results are better. Patients with endometriosis have three major risks Menstrual pain, cysts, and infertility. Endometriosis causes abdominal pain during menstrual bleeding, which affects work life in serious cases, and the growing cysts may cause rupture of the cystic cavity, resulting in abdominal bleeding and emergency surgery. Therefore, whenever you have dysmenorrhea, you should be checked early and chocolate cysts should be actively treated. Can chocolate cysts rupture? Chocolate cysts accumulate too much fluid too quickly, coupled with external forces, there is a possibility of rupture, when to break, there is no obvious pattern, because the thick chocolate like fluid inside the cyst flows into the abdominal cavity, this fluid strongly stimulates the peritoneum, resulting in diffuse peritonitis, the patient suddenly lower abdomen severe pain, gradually spread to the whole abdomen, pressure pain, rebound pain, some accompanied by low fever, increased white blood cells, serious cases of shock. The diagnosis is clear and immediate surgery should be performed to reduce ectopic endothelial lesions, continued implantation and peritoneal adhesions caused by irritation of the peritoneum by cystic fluid, which can be life-threatening if not rescued in time. Therefore, if timely measures are taken for early treatment to prevent its rupture, especially the use of ultrasound interventional sclerotherapy, the method is simple and highly effective. The treatment is simple and does not lead to a major disaster. Can recurrence occur after laparoscopic and surgical treatment? Endometriosis can occur in any part of the body organs, commonly in the ovaries and uterus. When chocolate cysts occur in the ovaries they are called ovarian chocolate cysts, which tend to have thick walls, are not smooth and adhere to the surrounding tissues, and almost never do not rupture during surgical separation, and may form new lesions if not cleaned up. What is the principle of ultrasound-guided puncture sclerotherapy? Does it cause implantation and recurrence? The principle is to use a special needle to puncture into the cyst under direct ultrasound monitoring, avoiding the large blood vessels, draw out the intracapsular fluid, flush it out, and inject anhydrous alcohol and other sclerosing agents to cause coagulation and necrosis of the ectopic endometrial cells in the cyst wall so that it will no longer bleed every menstrual cycle to form a chocolate-like cyst, and to close the cyst wall adhesively. If the injection is made with endocrine drugs, the principle is to inhibit ovulation, which also inhibits the endometrial cells from bleeding, and over time the cyst wall is bonded and absorbed. The cyst wall itself is formed by the peritoneum, and there is no other tissue, so there is no other harm in the abdominal cavity. There are two ways of accessing the needle for chocolate cysts, one is through the vagina, this method requires exposure of the perineum and is inconvenient for the patient, but the images are clear and no anesthesia is needed. The other way is through the abdominal wall, where the needle is stable during the operation and easy for the doctor to operate. Regardless of the method of needle entry, it does not cause spillage of cystic fluid, plus clean flushing. From the related reports, it is very safe and effective as long as it is carefully operated by specially trained ultrasonographers, and no cases of implantation or recurrence have been found after our observation of hundreds of cases of chocolate cysts treated by puncture. However, this treatment is not etiologically specific, whether surgical excision, laparoscopy or ultrasound intervention, it is specific to the treated cyst, while new chocolate cysts can still form on the contralateral side or in the adjacent tissue of the treated area if there is ectopic endometrial tissue. How big is a chocolate cyst for puncture treatment? For pelvic cysts puncture treatment is generally difficult to enter the needle for small cysts, especially (in obese people), but it is effective and less expensive; it is easy to enter the needle for large cysts and expensive. Cysts between 4.0 and 6.0 cm are the best period for treatment, and more than 7.0 cm sometimes need to be treated twice. The best time for puncture is the 3rd-10th day after menstruation, when the endometrium is recovering, and it is not advisable to puncture when menstruation is coming or during menstruation. Is it necessary to take medication after chocolate cyst puncture treatment? The disappearance of cysts after chocolatocyst puncture treatment is directly related to the number of times the cystic cavity is irrigated and the dose of sclerotherapy injected by the puncture operation. If the puncture irrigation is complete and all the cystic fluid has been removed, the appropriate amount of sclerosing agent is injected and withdrawn in equal amounts, the drug injected into the cyst is retained and the whole procedure is standardized. Postoperative application of antibiotics for 3-5 days, no need to continue to take other drugs orally, but also after puncture, according to the condition, continue to take such as mifepristone, intramuscular injection and other drugs, in order to consolidate the effect of treatment. Can I get pregnant after a chocolate cyst puncture? Endometriosis is one of the main causes of infertility. Puncture treatment does not damage the ovaries and fallopian tubes. Chocolate cysts are definitely an obstacle to pregnancy, and ultrasound intervention is very helpful after treatment. However, the factors of pregnancy are many and complex. If the infertility is caused by a single factor of chocolate cyst, pregnancy will occur soon after treatment, and a significant number of the cases we treat are very lucky. If pregnancy does not occur even after treatment, multiple factors such as male sperm, female follicle monitoring, tubal patency, endometrium and myometrium, and mental environment are investigated one by one.