Obstructive rectal endometriosis treated by robot-assisted laparoscopic surgery: a case report

Naotaka Kuriyama, Koji Ando, Qingjiang Hu, Yu Miyashita, Yoshiaki Fujimoto, Tomoko Jogo, Kentaro Hokonohara, Ryota Nakanishi, Yuichi Hisamatsu, Yasue Kimura, Daisuke Tsurumaru, Kenichi Kohashi, Yoshinao Oda, Eiji Oki, Masataka Nishimura, Masaki Mori
Surgical case reports · 2020 · vol. 6(1) , pp. 211 · doi:10.1186/s40792-020-00977-9 · PMID:32797328 · PMC7427829 · W3049246775
article OA: gold CC0 ⤵ 1 in-corpus citation
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

A robot-assisted laparoscopic low anterior resection was used to treat a woman with obstructive rectal endometriosis, a condition difficult to diagnose preoperatively, confirming endometriosis in the resected specimen.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This paper reports a 43-year-old woman with suspected upper rectal cancer/other malignancy due to rectal stenosis, evaluated with colonoscopy, barium enema, contrast CT, FDG-PET, MRI, and diagnostic laparoscopy. Preoperatively, diagnosis of obstructive rectal endometriosis was not confirmed, despite a 2-year history of constipation and a left ovarian “chocolate cyst” with mild rectal adhesions; robotic-assisted laparoscopic low anterior resection with D3 lymphadenectomy was performed for both diagnosis and treatment, and dense adhesion between rectum and left ovary made resection difficult. Pathology of the resected specimen showed endometrial glands and stroma extending through the submucosa to subserosa, with estrogen and progesterone receptor positivity, confirming rectal endometriosis; the main limitation is that this is a single case report with no preoperative definitive diagnostic yield beyond post-surgical pathology. This paper is centrally about endometriosis — it specifically describes obstructive rectal endometriosis presenting as malignant-like rectal stenosis and treated by robot-assisted laparoscopic low anterior resection.

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Abstract

BACKGROUND: Rectal endometriosis is a rare disease. A definitive diagnosis prior to surgery is often difficult. We encountered a patient with rectal sub-obstructive endometriosis that was treated by robot-assisted laparoscopic low anterior resection. CASE PRESENTATION: A 43-year-old woman visited our hospital with suspected stenosis caused by upper rectal cancer. She had a 2-year history of constipation. We were unable to confirm the diagnosis through detailed examinations, including laparoscopy. Robot-assisted laparoscopic low anterior resection with D3 lymph node dissection was performed for both diagnosis and treatment. The postoperative specimen showed a submucosal tumor. The pathological examination confirmed rectal endometriosis. CONCLUSIONS: We herein describe a rare case of obstructive rectal endometriosis that we were unable to diagnose preoperatively. Robotic surgery was useful in this case, which involved extensive pelvic adhesion.

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endometriosis

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