Classification of Acosta et al for Pelvic Endometriosis

Acosta et al developed a classification of pelvic endometriosis based on extent of disease.

Sites of involvement:

(1) ovarian

(2) tubal

(3) peritoneum and cul de sac

(4) bladder or urinary tract

Ovarian Involvement	Severity
rare surface implants; no endometriomas, no surface scarring, no periovarian adhesions	mild
endometriosis involving one or both ovaries with several surface lesions, with scarring and retraction, or small endometriomas	moderate
minimal periovarian adhesions associated with ovarian lesions	moderate
endometriomas involving one or both ovaries with endometriomas greater than 2 cm in diameter	severe
one or both ovaries bound down with adhesions associated with endometriosis, with or without tubal adhesions to the ovaries	severe

Tubal Involvement	Severity
no peritubular adhesions	mild
minimal peritubular adhesions associated with ovarian lesions	moderate
one or both tubes bound down or obstructed by endometriosis, with associated adhesions	severe

Peritoneum and Cul de Sac Involvement	Severity
scattered fresh lesions without scarring or retraction	mild
superficial with scarring, retraction and some adhesions	moderate
obliteration of the cul de sac from adhesions or lesions associated with endometriosis	severe
thickening of the uterosacral ligaments and cul de sac lesions from invasive endometriosis, with obliteration of the cul de sac	severe

Bladder or Urinary Tract Involvement	Severity
significant bowel, urinary bladder or ureteral involvement	severe

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