PURPOSE: The aim of this study was to evaluate the results of aggressive surgical management in patients with advanced colorectal endometriosis. METHODS: The medical records of 130 women who had undergone aggressive surgical management of advanced colorectal endometriosis were reviewed. They were then interviewed a mean of 60 months following surgery and asked to rank relief of their symptoms. RESULTS: The most common symptoms before surgery were pelvic pain, dyspareunia, rectal pain, change in bowel habit, and cyclic rectal bleeding. Colorectal operations included low anterior resection, sigmoid resection, disc excision of the rectal wall, right colectomy, appendectomy, and small bowel resection. At follow-up symptom relief was high, ranging from 100 percent in cyclic bleeding to 91 percent for rectal pain. Mortality and clinical leakage rates were 0 percent, small bowel obstruction 3 percent, and abscess 1 percent. The crude pregnancy rate following surgery was 49 percent. CONCLUSIONS: These findings strongly support the use of aggressive surgical extirpation of all visible colorectal endometriosis for patients with advanced disease.

Aggressive surgical management for advanced colorectal endometriosis

Background
The rectosigmoid colon is affected by deep pelvic endometriosis in 3–37% of cases. In the past, treatment of the affected gastrointestinal tract generally required conversion to conventional surgery. We describe our experience with complete laparoscopic management of deep pelvic endometriosis with bowel involvement.

Laparoscopic colorectal resection for endometriosis

Endometriosis, a condition defined by the presence of ectopic endometrium, is a disorder of increasing incidence and a significant cause of gastroenterologic distress in young women. Although clinical manifestations vary considerably depending upon the anatomic extent of disease, characteristic abdominal complaints and typical physical findings continue to be associated with misdiagnosis and delayed recognition of gastrointestinal involvement. The authors of this paper review the medical literature concerning endometriosis of the digestive tract--emphasizing modes of presentation, risk factors, diagnostic testing, complications, and therapy. Greater familiarity with the disease and heightened awareness of its sequellae are needed and prerequisite to improved medical management.

Endometriosis. An important condition in clinical gastroenterology.

Mucosal changes in the large bowel with endometriosis: A possible cause of misdiagnosis of colitis?

Colon and rectal endometriosis is a relatively rare entity that may have a wide array of clinical symptomatology and radiographic findings. Thirty-two patients with a diagnosis of colon or rectal endometriosis were seen and treated at the Ferguson Clinic between 1960 and 1986. Diagnostic, pathologic, and therapeutic findings were reviewed. All patients, except one, had large-bowel symptoms. Ten patients had previous histories of pelvic endometriosis. When endometriosis in the colon causes significant symptoms or a neoplasm cannot be ruled out, partial colectomy is recommended. If pelvic endometriosis is extensive, removal of the endometriomas and reproductive organs should be entertained concurrent with bowel resection. Hormonal manipulation may be attempted in certain select patients with very close follow-up.

Diagnosis and management of endometriosis of the colon and rectum.

Reviewed are the clinical, radiologie, operative and pathologic findings and the results in 14 women (ages 31 to 51 years) requiring partial colectomy for endometriosis. All had symptoms related to the lesion of the colon; eight had gynecologic symptoms. In only four instances did the physical examination reveal a palpable mass. Most important in making the preoperative diagnosis is radiographie examination of the colon (barium enema). In common localized endometrioma, features are those of an eccentric intramural, submucosal lesion with transverse ridging. More extensive endometriosis is more difficult to differentiate from carcinoma by radiographie means. Operative diagnosis, which was less accurate than radiologie diagnosis, should be suggested by uninvolved mucosa on examination of the unopened colon and frozen section diagnosis of endometriosis on an implant. When endometriosis of the colon is of a degree sufficient to cause symptoms, partial colectomy should be done; oophorectomy only, without resection, is not recommended.

Haley Rl

Papers

Endometriosis of the colon: report of 14 patients requiring partial colectomy.