Intestinal endometriosis: presentation, investigation, and surgical management

Iain Cameron, S. Rogers, Mick Collins, Malcolm Reed
In: International Journal of Colorectal Disease · 1995 · vol. 10(2) , pp. 83–86 · doi:10.1007/bf00341202 · W2064682419
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This study identified 26 cases of intestinal endometriosis, most commonly in the rectosigmoid, presenting with abdominal pain, and found preoperative diagnosis difficult without laparoscopy.

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This study identified 26 cases of intestinal endometriosis over 14 years and described their presenting features, investigation, and surgical management. The most common locations were the rectosigmoid region (11 cases), appendix (9), and ileocaecal region (6), with abdominal pain (20 cases) often accompanied by nausea/vomiting (12) or altered bowel habit (10), and other symptoms including rectal bleeding, bloating, and tenesmus. Endometriosis was not suspected preoperatively in any patients without a prior history, and accurate preoperative diagnosis was described as very difficult, with laparoscopy providing definite evidence prior to formal surgery. Colonic resections, small bowel resections, and appendicectomy were performed with resection of adjacent adherent structures, highlighting intestinal endometriosis’s tendency to mimic carcinoma and inflammatory bowel disease. This paper is centrally about endometriosis — specifically the presentation, investigation, and surgical management of intestinal endometriosis.

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Abstract

The study was undertaken to identify the presenting features of intestinal endometriosis and to evaluate its investigation and surgical management. Twenty-six cases of intestinal endometriosis were identified during a fourteen year period. The commonest site of occurrence was the rectosigmoid region (11 cases) followed by the appendix (9 cases), and ileocaecal region (6 cases). Abdominal pain was the main presenting feature in 20 cases, with associated nausea and vomiting in 12 cases and altered bowel habit in ten. Other presenting features included rectal bleeding, abdominal bloating and tenesmus. Endometriosis was not suspected preoperatively in any of the patients without a past history of this condition. Accurate preoperative diagnosis proved very difficult, with only laparoscopy providing definite evidence of intestinal endometriosis prior to formal surgery. Colonic resections were performed in 12 cases, small bowel resection in six cases and appendicectomy in nine cases, together with resection of adjacent adherent structures. This series illustrates the difficulty of establishing an accurate preoperative diagnosis, and the propensity of intestinal endometriosis to mimic other gastrointestinal diseases, particularly carcinoma and inflammatory bowel disease.
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Abstract

The study was undertaken to identify the presenting features of intestinal endometriosis and to evaluate its investigation and surgical management. Twenty-six cases of intestinal endometriosis were identified during a fourteen year period. The commonest site of occurrence was the rectosigmoid region (11 cases) followed by the appendix (9 cases), and ileocaecal region (6 cases). Abdominal pain was the main presenting feature in 20 cases, with associated nausea and vomiting in 12 cases and altered bowel habit in ten. Other presenting features included rectal bleeding, abdominal bloating and tenesmus. Endometriosis was not suspected preoperatively in any of the patients without a past history of this condition. Accurate preoperative diagnosis proved very difficult, with only laparoscopy providing definite evidence of intestinal endometriosis prior to formal surgery. Colonic resections were performed in 12 cases, small bowel resection in six cases and appendicectomy in nine cases, together with resection of adjacent adherent structures. This series illustrates the difficulty of establishing an accurate preoperative diagnosis, and the propensity of intestinal endometriosis to mimic other gastrointestinal diseases, particularly carcinoma and inflammatory bowel disease. Résumé Cette étude a été entreprise afin d'identifier les manifestations cliniques d'une endométriose intestinale et d'évaluer les modes d'investigation et le traitement chirurgical. Vingt-six cas d'endométriose intestinale ont été identifiés au cours d'une période de 14 ans. Le lieu le plus fréquent de développement de l'endométriose est la région recto-sigmïdienne (11 cas) suivie de l'appendice (9 cas) et de la région iléocaecale (6 cas). La douleur abdominale constitue la manifestation la plus importante chez 20 patients et est associée des nausées et des vomissements chez 12 patients ainsi que des altérations du transit chez 10 patients. D'autres manifestations sont constituées par le saignement rectal, le ballonnement abdominal et des ténesmes. L'endométriose n'a jamais été suspectée en pré-opératoire chez aucun des patients qui ne comportait pas d'anamnèse de cette affection. Un diagnostic précis pré-opératoire est très difficile; seule la laparoscopie permet d'affirmer le diagnostic d'endométriose intestinale avant une chirurgie d'exérèse. Des résections coliques ont été réalisées chez 12 patients; des résections de l'intestion grêle chez 6, une appendicectomie chez 9 en association à des excisions des tissus adhérents adjacents. Cette série illustre les difficultés dans l'établissement d'un diagnostic pré-opératoire précise et la tendance de l'endométriose intestinale à mimer d'autres affections digestives, en particulier le cancer et les maladies inflammatoires de l'intestin. Similar content being viewed by others

References

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