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Photograph of bowel adherent to the left pelvic sidewall and left adnexal structures in such a way that the bowel overlies the left fallopian tube and left ovary when the woman is flat on her back or on her feet. Intraoperatively (during the laparoscopy) and at the time of this picture the patient was in steep Trendelenburg position (the head of the table was lowered toward the floor and the foot of the table was elevated toward the ceiling, so that the free intraabdominal contents could be positioned outside of the pelvis) with the bowel being pushed superiorly using a probe (silver cylindrical instrument seen in the photograph). The sites of adhesion between the bowel and the adnexal structures can be lysed but great care needs to be exercised during these cases since several large vessels (and the ureter) are contained immediately behind the peritoneum in this general region. Freeing the bowel from this area of the pelvis may restore a more normal relationship between the fallopian tube and the ovary (if the bowel overlies these structures fairly continuously then the ability of the fallopian tube to obtain the egg from the ovary may be impaired).
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