DEEP INTESTINAL ENDOMETRIOSIS INFILTRATING THE URETER – SURGICAL MANAGEMENT

Sérgio Eduardo Alonso Araújo, Rodrigo Moisés de Almeida Leite, Gustavo Yano Callado, Leandro Cardoso Barchi, Ana Sarah Portilho, Bruno Zilberstein
In: Journal of Coloproctology · 2023 · vol. 43(S 01) , pp. S1–S270 · doi:10.1055/s-0044-1781255 · W4392668605
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This paper presents a video case report of surgical management for deep infiltrating intestinal endometriosis involving the ureter and the rectosigmoid region in a patient admitted for chronic pain and constipation. Diagnostic laparoscopy identified large endometriosis lesions in the rectum, uterus, right ureter, appendix, and terminal ileum, and the authors performed laparoscopic rectosigmoidectomy with primary anastomosis, ureterectomy with double-J placement and ureteral anastomosis, appendectomy, and shaving of enteric lesions. The minimally invasive approach was reported to have a good postoperative recovery, with clear-liquid diet started on postoperative day 2 and double-J removal after 30 days by flexible ureteroscopy. This paper is centrally about endometriosis — specifically laparoscopic surgical treatment of deep infiltrating intestinal endometriosis infiltrating the ureter.

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Abstract

Introduction Deep infiltrating intestinal endometriosis is a serious medical condition associated with chronic pain, intestinal obstruction, peritoneal adhesions, and reduced quality of life. Up to 30% of women diagnosed with endometriosis present lesions in the gastrointestinal tract. The most prevalent sites for endometriosis lesions are the rectum and sigmoid colon, specially in the rectosigmoid transition. Deep infiltrating lesions may involve the rectovaginal septum, the sacroiliac ligaments, he ureters, and the bladder.
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Introduction

Deep infiltrating intestinal endometriosis is a serious medical condition associated with chronic pain, intestinal obstruction, peritoneal adhesions, and reduced quality of life. Up to 30% of women diagnosed with endometriosis present lesions in the gastrointestinal tract. The most prevalent sites for endometriosis lesions are the rectum and sigmoid colon, specially in the rectosigmoid transition. Deep infiltrating lesions may involve the rectovaginal septum, the sacroiliac ligaments, he ureters, and the bladder. Case Report We present a video of the surgical management of a patient presenting deep infiltrating endometriosis lesions admitted to elective surgery due to chronic pain and constipation. Upon diagnostic laparoscopy, large endometriosis lesions could be observed in the rectum, uterus, right ureter, appendix, and terminal ileum. We conducted laparoscopic rectosigmoidectomy with primary anastomosis, ureterectomy with double-J placement and ureteral anastomosis, appendectomy, and shaving of the enteric lesions. The procedure was minimally invasive in its entirety. The patient presented good postoperative recovery, starting clear-liquid diet on postoperative day 2. The double-J catheter was removed by flexible ureteroscopy 30 days after the procedure.

Conclusion

The laparoscopic management of deep endometrial lesions involving the ureters and the retosigmoid junction is a safe and effective therapy for intestinal endometriosis. Publication History Article published online: 27 February 2024 © 2024. Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/) Thieme Revinter Publicações Ltda. Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

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