Pathophysiological approach to bowel dysfunction after segmental colorectal resection for deep endometriosis infiltrating the rectum: a preliminary study

Laura Armengol-debeir, Armengol-Debeir L, Laura Armengol‐Debeir, Guillaume Savoye, Anne-marie Leroi, Anne‐Marie Leroi, Leroi AM, Guillaume Gourcerol, Savoye-Collet C, Céline Savoye-Collet, Tuech JJ, Jean‐Jacques Tuech, Jean-Jacques Tuech, Maud Vassilieff, Vassilieff M, M. Vassilieff, Roman H, Horace Roman
Human Reproduction · 2011 · vol. 26(9) , pp. 2330–2335 · doi:10.1093/humrep/der190 · PMID:21705371 · W2132296671
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This study investigated the pathophysiological mechanisms of post-operative constipation in women after colorectal resection for deep endometriosis, identifying stenosis, neurological issues, intussusception, and transit problems.

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Abstract

BACKGROUND: Colorectal segmental resection is performed worldwide in a majority of women presenting with symptomatic deep endometriosis infiltrating the rectum. The aim of the present study was to investigate the pathophysiological mechanisms involved in post-operative digestive dysfunction. METHODS: We selected patients managed by colorectal resection for rectal endometriosis, who had developed post-operative severe constipation and whose follow up was superior to 24 months. To assess the mechanisms involved in the pathogenesis of this complaint, we performed a step-by-step work up including: low digestive tract endoscopy, colonic transit time measurement and when appropriate anorectal manometry, electromyography and defecographic evaluation. RESULTS: Five out of 25 (20%) patients, whose age ranged from 27 to 41 years, were investigated for severe post-operative terminal constipation. Four different mechanisms responsible for terminal constipation were identified: tight stenosis of the colorectal anastomosis, post-operative neurological sequelae, colonic intussusception through the colorectal anastomosis and transit constipation that developed post surgery. CONCLUSIONS: Post-operative constipation is a frequent complaint in women managed by colorectal resection for rectal endometriosis. A multidisciplinary approach is mandatory as pathophysiologic mechanisms may vary and prove difficult to understand. The risk of post-operative bowel dysfunction following colorectal endometriosis must be taken into account whenever this technique is proposed in young women presenting with a benign disease such as deep endometriosis.

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Condition tags

endometriosis

MeSH descriptors

Constipation Digestive System Surgical Procedures Endometriosis Postoperative Complications Postoperative Complications Rectal Diseases Adult Adult Anastomosis, Surgical Anastomosis, Surgical Colonic Diseases Colonic Diseases Colonic Diseases Constipation Constipation Constriction, Pathologic Constriction, Pathologic Constriction, Pathologic Digestive System Surgical Procedures Digestive System Surgical Procedures

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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. Outer rings show 2-hop neighbours — papers reached through the immediate citers/citees. [ collapse to 1-hop ]

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License: CC0 · commercial use OK