Management of rectosigmoid obstruction due to severe bowel endometriosis

Bowel obstruction is a rare complication of intestinal endometriosis. The aim of this work was to evaluate outcomes after colorectal resection for bowel obstruction due to endometriosis. Of 720 patients who underwent colorectal resection for bowel endometriosis, 12 (1.7 %) presented with bowel obstruction. Preoperative work-up, management, perioperative and long-term outcomes were analyzed. All lesions were localized in the rectosigmoid tract. All patients underwent colorectal resection, which was carried out laparoscopically in 4 (33 %). Rate of low or ultra-low colorectal anastomoses was 83 %. Four patients (33 %) required blood transfusions. Two patients developed rectovaginal fistulas. After a median follow-up of 38 months, there were no cases of disease recurrence and dyschezia improved in 75 % of patients. Bowel endometriosis should be considered in the differential diagnosis of young women with bowel obstruction. Despite challenging operations, colorectal resections are associated with good outcomes. Similar content being viewed by others

Giudice LC, Kao LC (2004) Endometriosis. Lancet 364:1789–1799 Bailey HR, Ott MT, Hartendorp P (1994) Aggressive surgical management for advanced colorectal endometriosis. Dis Colon Rectum 37:747–753 Dousset B, Leconte M, Borghese B, Millischer AE, Roseau G, Arkwright S, Chapron C (2010) Complete surgery for low rectal endometriosis: long-term results of a 100—case prospective study. Ann Surg 251:887–895 Minelli L, Fanfani F, Fagotti A, Ruffo G, Ceccaroni M, Mereu L, Landi S, Pomini P, Scambia G (2009) Laparoscopic colorectal resection for bowel endometriosis: feasibility, complications, and clinical outcome. Arch Surg 144:234–239 Clement PB (2007) The pathology of endometriosis: a survey of the many faces of a common disease emphasizing diagnostic pitfalls and unusual and newly appreciated aspects. Adv Anat Pathol 14:241–260 Takai N, Ueda T, Nishida M, Nasu K, Narahara H (2008) Bowel obstruction due to endometriosis in the rectovaginal septum. Clin Exp Obstet Gynecol 35:295–296 de Jong MJ, Mijatovic V, van Waesberghe JH, Cuesta MA, Hompes PG (2009) Surgical outcome and long-term follow-up after segmental colorectal resection in women with a complete obstruction of the rectosigmoid due to endometriosis. Dig Surg 26:50–55 De Ceglie A, Bilardi C, Blanchi S, Picasso M, Di Muzio M, Trimarchi A, Conio M (2008) Acute small bowel obstruction caused by endometriosis: a case report and review of the literature. World J Gastroenterol 14:3430–3434 Ruffo G, Scopelliti F, Scioscia M, Ceccaroni M, Mainardi P, Minelli L (2010) Laparoscopic colorectal resection for deep infiltrating endometriosis: analysis of 436 cases. Surg Endosc 24:63–67 Stepniewska A, Pomini P, Guerriero M, Scioscia M, Ruffo G, Minelli L (2010) Colorectal endometriosis: benefits of long-term follow-up in patients who underwent laparoscopic surgery. Fertil Steril 93:2444–2446 Garry R, Clayton R, Hawe J (2000) The effect of endometriosis and its radical laparoscopic excision on quality of life indicators. BJOG 107:44–54 Daraï E, Dubernard G, Coutant C, Frey C, Rouzier R, Ballester M (2010) Randomized trial of laparoscopically assisted versus open colorectal resection for endometriosis: morbidity, symptoms, quality of life, and fertility. Ann Surg 251:1018–1023 Revised American Society for Reproductive Medicine classification of endometriosis: 1996 (1997) Fertil Steril 67:817–821 Landi S, Ceccaroni M, Perutelli A, Allodi C, Barbieri F, Fiaccavento A, Ruffo G, McVeigh E, Zanolla L, Minelli L (2006) Laparoscopic nerve-sparing complete excision of deep endometriosis: is it feasible? Hum Reprod 21:774–781 Kim KJ, Jung SS, Yang SK, Yoon SM, Yang DH, Ye BD, Byeon JS, Myung SJ, Kim JH (2011) Colonoscopic findings and histologic diagnostic yield of colorectal endometriosis. J Clin Gastroenterol 45:536–541 Yantiss RK, Clement PB, Young RH (2001) Endometriosis of the intestinal tract: a study of 44 cases of a disease that may cause diverse challenges in clinical and pathologic evaluation. Am J Surg Pathol 25:445–454 Piketty M, Chopin N, Dousset B, Millischer-Bellaische AE, Roseau G, Leconte M, Borghese B, Chapron C (2009) Preoperative work-up for patients with deeply infiltrating endometriosis: transvaginal ultrasonography must definitely be the first-line imaging examination. Hum Reprod 24:602–607 Vassilieff M, Suaud O, Collet-Savoye C, Da Costa C, Marouteau-Pasquier N, Belhiba H, Tuech JJ, Marpeau L, Roman H (2011) Computed tomography-based virtual colonoscopy: an examination useful for the choice of the surgical management of colorectal endometriosis. Gynecol Obstet Fertil 39:339–345 Laghi A, Rengo M, Graser A, Iafrate F (2012) Current status on performance of CT colonography and clinical indications. Eur J Radiol 82(8):1192–1200 Biscaldi E, Ferrero S, Fulcheri E, Ragni N, Remorgida V, Rollandi GA (2007) Multislice CT enteroclysis in the diagnosis of bowel endometriosis. Eur Radiol 17:211–219 Loubeyre P, Petignat P, Jacob S, Egger JF, Dubuisson JB, Wenger JM (2009) Anatomic distribution of posterior deeply infiltrating endometriosis on MRI after vaginal and rectal gel opacification. AJR 192:1625–1631 Faccioli N, Manfredi R, Mainardi P, Dalla Chiara E, Spoto E, Minelli L, Mucelli RP (2008) Barium enema evaluation of colonic involvement in endometriosis. AJR 190:1050–1054 Faccioli N, Foti G, Manfredi R, Mainardi P, Spoto E, Ruffo G, Minelli L, Mucelli RP (2010) Evaluation of colonic involvement in endometriosis: double-contrast barium enema vs. magnetic resonance imaging. Abdom Imaging 35:414–421 Anaf V, El Nakadi I, De Moor V, Coppens E, Zalcman M, Noel JC (2009) Anatomic significance of a positive barium enema in deep infiltrating endometriosis of the large bowel. World J Surg 33:822–827 Hudelist G, Tuttlies F, Rauter G, Pucher S, Keckstein J (2009) Can transvaginal sonography predict infiltration depth in patients with deep infiltrating endometriosis of the rectum? Hum Reprod 24:1012–1017 Goncalves MO, Podgaec S, Dias JA Jr, Gonzalez M, Abrao MS (2010) Transvaginal ultrasonography with bowel preparation is able to predict the number of lesions and rectosigmoid layers affected in cases of deep endometriosis, defining surgical strategy. Hum Reprod 25:665–671 Ruffo G, Sartori A, Crippa S, Partelli S, Barugola G, Manzoni A, Steinkasserer M, Minelli L, Falconi M (2012) Laparoscopic rectal resection for severe endometriosis of the mid and low rectum: technique and operative results. Surg Endosc 26:1035–1040 Acknowledgments All authors report no funding nor relevant financial relationship. Conflict of interest None. Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Ruffo, G., Crippa, S., Sartori, A. et al. Management of rectosigmoid obstruction due to severe bowel endometriosis. Updates Surg 66, 59–64 (2014). https://doi.org/10.1007/s13304-013-0240-1 Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s13304-013-0240-1