Intestinal endometriosis: a diagnostic dilemma

Sunil Kumar Juneja, Satpal Singh Virk, Saurabh Singla, Kamal Sachdeva, Harpreet Kaur, Anjali Sharma
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2019 · vol. 8(3) , pp. 1139 · doi:10.18203/2320-1770.ijrcog20190894 · W2915551979
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This retrospective study on eight patients found that intestinal endometriosis, particularly colon involvement, can present as partial or complete bowel obstruction and remains a diagnostic challenge.

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This retrospective observational study examined eight patients to characterize the clinical presentation and diagnostic challenges associated with intestinal endometriosis. The results indicated that small intestinal involvement occurred in 37.5% of cases while colonic involvement was present in 62.5%, with one patient experiencing complete bowel obstruction and others showing partial obstruction. The authors conclude that intestinal endometriosis is a significant diagnostic dilemma that requires consideration in menstruating women presenting with gastrointestinal symptoms, noting that laparoscopy with biopsy remains the gold standard for diagnosis and potential surgical resection. This paper is centrally about endometriosis — specifically focusing on its manifestation as intestinal endometriosis leading to bowel obstruction.

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Abstract

Background: Endometriosis is a benign gynaecological condition that causes significant morbidity to women of reproductive age group. It uncommonly affects the gastrointestinal tract and acute bowel obstruction is a rare manifestation.Methods: A retrospective observational study was conducted on eight patients.Results: In three patients (37.5%), small intestinal involvement was seen, and colon was involved in five patients (62.5%). One (12.5%) patient presented with complete bowel obstruction while in others partial obstruction of the intestine was seen.Conclusions: Intestinal endometriosis is a diagnostic challenge and should be considered in young menstruating women with gastrointestinal symptoms. Intestinal endometriosis is the most common extra-pelvic site and it is found in 12% of women with endometriosis. The true incidence of endometriosis causing bowel obstruction is unknown. Pre or intraoperative sigmoidoscopy may prove helpful in ruling out malignancy. The gold standard for diagnosis is laparoscopy and biopsy, which allows a full assessment of the pelvis as well as surgical resection if required. The management of endometriosis is an integrated approach of both medical and surgical therapy. Bowel resection is usually undertaken if there are features of obstruction or bleeding, and if there is suspicion of malignancy.
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Background

Endometriosis is a benign gynaecological condition that causes significant morbidity to women of reproductive age group. It uncommonly affects the gastrointestinal tract and acute bowel obstruction is a rare manifestation.

Methods

A retrospective observational study was conducted on eight patients.

Results

In three patients (37.5%), small intestinal involvement was seen, and colon was involved in five patients (62.5%). One (12.5%) patient presented with complete bowel obstruction while in others partial obstruction of the intestine was seen.

Conclusions

Intestinal endometriosis is a diagnostic challenge and should be considered in young menstruating women with gastrointestinal symptoms. Intestinal endometriosis is the most common extra-pelvic site and it is found in 12% of women with endometriosis. The true incidence of endometriosis causing bowel obstruction is unknown. Pre or intraoperative sigmoidoscopy may prove helpful in ruling out malignancy. The gold standard for diagnosis is laparoscopy and biopsy, which allows a full assessment of the pelvis as well as surgical resection if required. The management of endometriosis is an integrated approach of both medical and surgical therapy. Bowel resection is usually undertaken if there are features of obstruction or bleeding, and if there is suspicion of malignancy. Metrics

References

Parazzini F, Esposito G, Tozzi L, Noli S, Bianchi S. Epidemiology of endometriosis and its comorbidities. Eur J Obstet Gynecol Reprod Biol. 2017;209:3-7. Frackiewicz EJ, Zarotsky V. Diagnosis and treatment of endometriosis. Expert Opin Pharmacother. 2003;4:67-82. Lin YH, Kuo LJ, Chuang AY, Cheng TI, Hung CF. Extrapelvic endometriosis complicated with colonic obstruction. J Chin Med Assoc. 2006;69:47-50 Rock JA, Howard W, Telinde. Endometrosis. Operative Gynaecol. 2015;22:424-5. Witz CA. Current concepts in the pathogenesis of endometriosis. Clin Obstet Gynecol.1999;42:566-85. Katsikogiannis N, Tsaroucha A, Dimakis K, Sivridis E, Simopoulos C. Rectal endometriosis causing colonic obstruction and concurrent endometriosis of the appendix: a case report. J. Med. Case Rep. 2011;5:320. Macafee CH, Greer HL. Intestinal endometriosis. A report of 29 cases and a survey of the literature. J. Obstet. Gynaecol. Br. Emp. 2016;196067:539-5. Tarjanne S, Sjöberg J, Heikinheimo O. Rectovaginal endometriosis-characteristics of operative treatment and factors predicting bowel resection. J Minim Invasive Gynecol. 2009;16(3):302-306. Scarmato VJ, Levine MS, Herlinger H, Wickstrom M, Furth EE, Tureck RW. Ileal endometriosis: radiographic findings in five cases. Radiol. 2000;214:509-512. Ribeiro PA, Rodrigues FC, Kehdi IP, Rossini L, Abdalla HS, Donadio N. Laparoscopic resection of intestinal endometriosis: a 5-year experience. J. Minim. Invasive Gynecol. 2006;13(5):442-6. Paksoy M, Karabicak I, Ayan F, Aydogan F. Intestinal obstruction due to rectal endometriosis. Mt Sinai J Med. 2005;72:405-8. Pramateftakis MG, Psomas S, Kanellos D, Vrakas G, Roidos G, Makrantonakis A. Large bowel obstruction due to endometriosis. Tech. Coloproctol. 2010;14(1):S87-9.

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Condition tags

endometriosis

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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