Surgical Outcome and Long-Term Follow-Up after Segmental Colorectal Resection in Women with a Complete Obstruction of the Rectosigmoid due to Endometriosis

Abstract

Introduction: Intestinal involvement is reported in up to 12% of women with endometriosis. Complete large bowel obstruction is a rare complication of intestinal endometriosis. It is estimated to occur in less than 1% of the cases. Objective: The aim of this study is to evaluate the surgical outcome and long-term follow-up after segmental colorectal resection in women with a complete obstruction of the rectosigmoid due to endometriosis. In addition, the diagnostic work-up is described and discussed in view of the current literature. Patients and Methods: We present a case series of 5 patients with a complete obstruction of the rectosigmoid due to endometriosis who were finally treated in our hospital within a multidisciplinary endometriosis team. We retrospectively analyzed all patients with this condition who were referred in the period January 2000 to December 2006. Results: All patients (mean age 31.8 years, range 25–43 years) underwent emergency surgery resulting in a diverting colostomy before referral to our hospital. The principal diagnostic tool used was magnetic resonance imaging which demonstrated in all patients multiorgan endometriosis with complete obstruction of the rectosigmoid. Thereafter, all patients underwent a segmental colorectal resection by re-laparotomy. The diagnosis intestinal endometriosis was histologically confirmed in all cases. After surgery no major complications occurred. During a follow-up of 18–36 months, residual symptoms such as chronic constipation, deep dyspareunia and chronic pelvic pain were reported in 2 patients. No recurrences of intestinal endometriosis occurred. Conclusion: In our case series, segmental colorectal resection showed a favorable surgical outcome with no major complications. In the long-term follow-up, a limited number of residual symptoms were reported and no recurrences occurred. Intestinal endometriosis as a cause of bowel obstruction is often a diagnostic challenge mimicking a broad spectrum of diseases. It should be included in the differential diagnosis in women of reproductive age presenting with any symptoms of bowel obstruction. Magnetic resonance imaging is recommended as the primary imaging technique in such cases. In our opinion, these patients should be treated in a multidisciplinary setting.

Laparoscopic rectal resection for severe endometriosis of the mid and low rectum: technique and operative results

“…Endometriosis, defined as presence of ectopic endometrial gland tissue outside the uterine cavity, is a benign condition that commonly affects women of reproductive age, representing one of the most common causes of pelvic pain [1]. Deep infiltrating endometriosis (DIE) is characterized by endometriosis implants that penetrate for more than 5 mm in the affected tissue [2].…”

“…In fact, endometriosis frequently involves the rectovaginal septum, and therefore endometriosis nodules can deeply invade the bowel wall of the mid/low rectum [4]. In this setting patients may complain of chronic pelvic pain, dyschezia, rectal bleeding, and progressive constipation up to bowel obstruction [1][2][3][4][5].…”

Assessment of Long-Term Bowel Symptoms After Segmental Resection of Deeply Infiltrating Endometriosis: A Matched Cohort Study

“…The treatment for severe endometriosis, particularly in patients with DIE involving the bowel, is often complex and may require a multidisciplinary surgical approach for symptomatic patients who do not improve with medical treatment [16][17][18]. Several case series involving segmental bowel resection for DIE have been reported in the literature, but these have been limited owing to a lack of validated questionnaires, small sample size, or absence of a control group that did not undergo bowel surgery [10,[19][20][21][22][23][24][25][26][27][28]. Moreover, some studies have lacked longterm follow-up [23,28].…”

Belet infiltráló endometriosis: a gasztroenterológia és a sebészet új kihívása? Vastagbélileust okozó endometriosis három esete és irodalmi áttekintés

“…Figyelemre méltó, hogy ezek közül 13 az utóbbi 6 évben jelent meg. A közlemények esetismertetések, De Jong és mtsai öt, ileus miatt operált beteg hosszú távú eredményeiről számolnak be, de ebben nem részletezik a betegek anamnézisét, kivizsgálását, így a feldolgozásba nem vettük bele [24].…”