Colonic endometriosis

Llewis MI, Martin I. Lewis, M I Llewis, Fred W. Rio, F Rio, Rio F
Diseases of the colon and rectum · 1969 · vol. 12(2) , pp. 137–141 · doi:10.1007/bf02629013 · PMID:5774850 · W2328748213
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Colonic endometriosis, suspected with cyclical obstructive symptoms, may present as a submucosal lesion or constriction on sigmoidoscopy or barium enema, with treatment varying by patient age and symptom severity.

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This case report describes the clinical presentation and management of colonic endometriosis affecting the sigmoid flexure and rectosigmoid area. The authors note that patients typically exhibit symptoms such as progressive colonic obstruction, dyschezia, abdominal cramps, and menstrual bleeding, though sigmoidoscopy often reveals no visible lesion despite submucosal involvement. Diagnostic imaging via barium enema may show a constricted area or polypoid lesion, but differentiating this condition from rectosigmoid carcinoma is difficult without histological confirmation. Treatment strategies vary based on patient age and symptom severity, ranging from hormonal suppression in younger women to hysterectomy with oophorectomy or surgical resection for those with obstruction or diagnostic uncertainty. This paper is centrally about endometriosis — specifically the gastrointestinal manifestations involving deep infiltrating disease of the colon.

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Abstract

Conclusion Endometriosis of the sigmoid flexure and rectosigmoidal area should be suspected in any woman who has symptoms of progressive colonic obstruction, pain on defecation, abdominal cramps and rectal bleeding associated with menstruation. Sigmoidoscopy should be performed in all these patients, but usually it will reveal no lesion. The only suggestive finding which might be found on sigmoidoscopy is a submucosal lesion covered by a puckered but intact mucosa. X-rays of the colon after barium enema may show a polypoid lesion but, more commonly, it will show a constricted area. Usually differentiation from carcinoma of the rectosigmoid is not possible by x-ray examination, but an intact mucosa in the narrowed area would favor a diagnosis of colonic endometriosis. Treatment should be determined according to the individual and should depend on the age of the patient and the severity of symptoms. Patients with minimal obstructive symptoms and moderate colonic involvement revealed by x-ray examination usually do not require a surgical operation. A patient in this category who is less than 40 years of age may show a remarkable response to suppressive hormonal therapy. Patients more than 40 years old may show dramatic relief of symptoms and regression of the colonic deformity after hysterectomy and oophorectomy. Surgical removal of the involved portion of the colon is indicated (1) in patients who have progressive or acute colonic obstruction associated with increasing pelvic discomfort, rectal bleeding and constipation associated with the menstrual cycle (2) to determine if the lesion is an adenocarcinoma of the rectosigmoid, and (3) when the x-ray examination shows a persistent constricted area in the rectosigmoid.
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Colonic endometriosis Report of a case - Martin I. Lewis - Fred Rio Conclusion Endometriosis of the sigmoid flexure and rectosigmoidal area should be suspected in any woman who has symptoms of progressive colonic obstruction, pain on defecation, abdominal cramps and rectal bleeding associated with menstruation. Sigmoidoscopy should be performed in all these patients, but usually it will reveal no lesion. The only suggestive finding which might be found on sigmoidoscopy is a submucosal lesion covered by a puckered but intact mucosa. X-rays of the colon after barium enema may show a polypoid lesion but, more commonly, it will show a constricted area. Usually differentiation from carcinoma of the rectosigmoid is not possible by x-ray examination, but an intact mucosa in the narrowed area would favor a diagnosis of colonic endometriosis. Treatment should be determined according to the individual and should depend on the age of the patient and the severity of symptoms. Patients with minimal obstructive symptoms and moderate colonic involvement revealed by x-ray examination usually do not require a surgical operation. A patient in this category who is less than 40 years of age may show a remarkable response to suppressive hormonal therapy. Patients more than 40 years old may show dramatic relief of symptoms and regression of the colonic deformity after hysterectomy and oophorectomy. Surgical removal of the involved portion of the colon is indicated (1) in patients who have progressive or acute colonic obstruction associated with increasing pelvic discomfort, rectal bleeding and constipation associated with the menstrual cycle (2) to determine if the lesion is an adenocarcinoma of the rectosigmoid, and (3) when the x-ray examination shows a persistent constricted area in the rectosigmoid.

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Condition tags

endometriosis

MeSH descriptors

Colonic Diseases Colonic Diseases Colonic Diseases Colonic Diseases Colon, Sigmoid Endometriosis Endometriosis Endometriosis Endometriosis Adult Castration Colonic Neoplasms Colonic Neoplasms Female Humans Hysterectomy Pregnancy

Citation neighborhood

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.

References (15)

Cited by (7)

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