Bowel Endometriosis: Presentation, Diagnosis, and Treatment

Remorgida, Valentino; Ferrero, Simone; Fulcheri, Ezio; Ragni, Nicola; Dc, Martin

doi:10.1097/01.ogx.0000268688.55653.5c

Cited by 280 publications

(221 citation statements)

References 54 publications

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confidence: 99%

“…[1][2][3][4] The most common location in the gastrointestinal tract is the sigmoid colon and rectum, followed by ileum, appendix, and cecum. 4 Although most patients with intestinal endometriosis have only mild symptoms, severe complications such as gastrointestinal tract bleeding, bowel obstruction, and perforation can occur. [5][6][7][8][9][10][11] Endoscopic and imaging findings may mimic other diseases including colitis, 12 idiopathic inflammatory bowel disease, 13 solitary rectal ulcer syndrome, 14 colorectal adenoma, and cancer.…”

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Endometriosis involving the mucosa of the intestinal tract: a clinicopathologic study of 15 cases

et al. 2013

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Endometriosis involving the mucosa of the intestines is rare, but may lead to diagnostic pitfalls. We reviewed 15 cases (seven biopsies and eight resections) from 14 patients. The patients' mean age is 48 years (31-66 years). Presenting symptoms included lower gastrointestinal bleeding, pelvic pain, rectal urgency, abdominal mass, and bowel obstruction. In the majority of cases, the lesion was located in the rectum (73%) with the remainder in the sigmoid colon (20%) and ileum (7%). The most common indication for biopsy was a polypoid lesion seen endoscopically (eight cases). For patients who underwent resections, the most common clinical impression was colonic carcinoma (75%), due to mass lesions and stricture as the most common macroscopic findings. Histologically, one case had stromal endometriosis only, but the remaining 14 cases had both endometrial glands and stroma. Epithelial metaplasia was present in all cases, mostly tubal metaplasia (ciliated epithelium). Hybrid glands and replacement of the surface epithelium by endometrial epithelium were also seen. Crypt architectural distortion, cryptitis, and crypt abscesses were seen in some cases, mimicking chronic active colitis or enteritis. A panel of immunohistochemical stains (CK7, CK20, CDX2, and ER) was found to be useful in biopsies with suspected endometriosis demonstrating unusual histology or only containing endometrioid stroma tissue. Vascular involvement by endometriosis was identified in one case. Endometrial hyperplasia (n ¼ 2) and cancer (n ¼ 1) were also seen in the ectopic tissue. All patients were alive at follow-up (3-216 months, mean 67 months).

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Endometriosis involving the mucosa of the intestinal tract: a clinicopathologic study of 15 cases

et al. 2013

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“…Bélendometriosisról beszélünk abban az esetben, ha az endometriumhoz hasonló szövet infi ltrálja a bélsubse-rosát, illetve eléri a subserosus neurovascularis plexust [5]. Amennyiben a folyamat csupán a serosát érinti, peritonealis endometriosisnak tekintjük az elváltozást [5,6].…”

Section: Die = Mélyen Infi Ltráló Endometriosis; Vas = Vizuális Analóunclassified

Experience with multidisciplinary laparoscopic surgery in patients with deep infiltrating colorectal endometriosis

et al. 2014

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Bevezetés: Mélyen infi ltráló bélendometriosisról beszélünk abban az esetben, ha az endometriumhoz hasonló szö-vet infi ltrálja a bél subserosáját, illetve eléri a subserosus neurovascularis plexust. Célkitűzés: A szerzők a vastagbelet érintő mélyen infi ltráló endometriosis miatt bélreszekción átesett betegek ellátása kapcsán szerzett tapasztalataikról számolnak be. Módszer: 2009 és 2012 között 50 betegnél végeztek a rectumot és/vagy a szigmabelet érintő mélyen infi ltráló endometriosis miatt szegmentális bélreszekciót. Eredmények: Ultramély reszekció 21 esetben, 29 esetben mély rectum, illetve szigma anterior reszekció történt. Valamennyi esetben szükség volt a rectumon kívül más szerveken is műtéti beavatkozásra endometriosis miatt. Leggyakrabban a belső női nemi szerveken (n = 47) és a húgy-hólyagon (n = 9), valamint az ureteren (n = 18) végeztek műtétet. A vastagbelet érintő mélyen infi ltráló endometriosiscsomók száma betegenként átlagosan 2,4±1,8 volt. Valamennyi esetben sikerült megőrizni a fertilitást. Súlyos sebészeti szövődmény (Clavien-Dindo III. stádium vagy súlyosabb) 3 esetben fordult elő (6%). Következtetések: Az eredmények azt igazolják, hogy a mélyen infi ltráló colorectalis endometriosis kezelésére alkalmazott szegmentális reszekció hatékony és biztonságos sebészi eljárás. Orv. Hetil., 2014, 155(5), 182-186. Kulcsszavak: mélyen infi ltráló colorectalis endometriosis, endometriosis, laparoszkópia Experience with multidisciplinary laparoscopic surgery in patients with deep infi ltrating colorectal endometriosisIntroduction: Deep infi ltrating endometriosis is a particular form of endometriosis that penetrates the peritoneal surface or it reaches the subserosal neurovascular plexus. Aim: The aim of the authors was to analyze the results of segmental colorectal resections performed for deep infi ltrating endometriosis. Method: Between 2009 and 2012, 50 patients underwent segmental rectum or/and sigmoid resection for endometriosis. Results: 21 patients had ultralow rectal resection and 29 patients had low colorectal anastomosis or anterior resection. Concomitant intervention in other organs was required in all cases, including gynecologic procedures (n = 50), additional gynecologic (n = 47), vesical (n = 9) and ureteral (n = 18) resections. The mean number of endometriosis lesions was 2.4±1.8 per patient. In all patients fertility was preserved. Severe surgical complications (Clavien-Dindo stage III or more severe) occurred in 3 patients (6%). Conclusions: The results confi rm that segmental bowel resection is an effi cient and safe method for the treatment of deep infi ltrating colorectal endometriosis.

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“…This investigation has become the gold standard for diagnosis of bowel endometriosis. 12,13 Rectal endoscopic ultrasound is also performed. This also helps in precise evaluation of the depth of infiltration of the lesion, Maximum size of the lesions and the distance of the lesions from the anus.…”

Section: Diagnosismentioning

confidence: 99%

“…11 Multidetector computerized tomographic enteroclysis (MDCT-e) has in recent years proven to become the diagnostic investigation for bowel endometriosis. 11,12 After adequate bowel preparation, colonic distension is done by introducing about 2000cc of water. During enteroclysis, pharmacologic inhibition of peristaltic waves is achieved by intravenous injection of hyoscine butyl bromide.…”

Section: Diagnosismentioning

confidence: 99%

Bowel endometriosis: a surgical red flag

Vagholkar

Murarka

Shetty

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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Endometriosis is a disease restricted usually to the female genital tract. Involvement of the bowel by this disease can lead to a diagnostic dilemma due to the great variation in the symptomatology. Awareness of the pathophysiology, clinical features and diagnostic modalities is of utmost importance to decide the modality of treatment. Hormonal manipulation and surgical resection are the two modalities of treatment. The choice depends upon critical analysis of clinical and radiological findings and the desire to have pregnancy in cases associated with infertility.

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Bowel Endometriosis: Presentation, Diagnosis, and Treatment

Cited by 280 publications

References 54 publications

Endometriosis involving the mucosa of the intestinal tract: a clinicopathologic study of 15 cases

Endometriosis involving the mucosa of the intestinal tract: a clinicopathologic study of 15 cases

Experience with multidisciplinary laparoscopic surgery in patients with deep infiltrating colorectal endometriosis

Bowel endometriosis: a surgical red flag

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