Rectal obstruction due to endometriosis

M. Mourthé de Alvim Andrade, Mourthé de Alvim Andrade M, Batista Pimenta M, Madalena Pimenta, M Batista Pimenta, BF Belezia, B de Freitas Belezia, de Freitas Belezia B, T Duarte, Thiago Dourado Duarte, Duarte T
Techniques in coloproctology · 2008 · vol. 12(1) , pp. 57–59 · doi:10.1007/s10151-008-0387-1 · PMID:18512014 · W1967644944
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Rectal endometriosis, though rare, can cause significant rectal stenosis and obstructive symptoms that require consideration in the differential diagnosis for women of reproductive age.

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This paper reports two cases of rectal endometriosis in reproductive-age women who initially presented with intestinal obstruction, with diagnosis pursued using decompressive colostomy and later laparoscopy with biopsy in one patient and prior pathology plus rectosigmoidectomy for a stenotic rectal segment in the other. The authors describe key findings that rare, circumferential rectal involvement by endometriosis can produce significant stenosis and obstructive symptoms that may resemble inflammatory or malignant disease. They conclude that rectal endometriosis should be considered in the differential diagnosis of rectal stenosis in women of childbearing age, though the evidence is limited to case reports. This paper is centrally about endometriosis — specifically rectal endometriosis causing rectal obstruction and stenosis.

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Abstract

Although endometriosis is a disorder commonly found in reproductive-age women, it does not involve the bowel very often. The circumferential involvement of the rectum is rare and the obstructive symptoms can be difficult to differentiate from those of inflammatory or malignant diseases. We report two patients with rectal endometriosis whose first prominent symptoms were those of intestinal obstruction. A 26-year-old woman was admitted with obstructive symptoms. In order to alleviate the obstruction and extend the preoperative evaluation, a decompressive colostomy was done. The diagnosis of endometriosis was made by laparoscopy and biopsies of the thickened cul-de-sac peritoneum. Another woman, 40 years of age, was referred to us with a colostomy. She had undergone a laparotomy due to an obstructive acute abdomen a year before, and a frozen pelvis was found. Biopsy specimens had been collected and the pathological report revealed endometrioma. A rectosigmoidectomy, encompassing the stenotic rectal segment, was done along with primary anastomosis. The pathological examination confirmed rectal endometriosis. The conclusion is that, although rare, rectal endometriosis can cause significant stenosis of the organ, leading to obstructive symptoms. Despite its low frequency, it should always be considered in the differential diagnosis of rectal stenosis involving women of childbearing age.
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Abstract

Although endometriosis is a disorder commonly found in reproductive-age women, it does not involve the bowel very often. The circumferential involvement of the rectum is rare and the obstructive symptoms can be difficult to differentiate from those of inflammatory or malignant diseases. We report two patients with rectal endometriosis whose first prominent symptoms were those of intestinal obstruction. A 26-year-old woman was admitted with obstructive symptoms. In order to alleviate the obstruction and extend the preoperative evaluation, a decompressive colostomy was done. The diagnosis of endometriosis was made by laparoscopy and biopsies of the thickened cul-de-sac peritoneum. Another woman, 40 years of age, was referred to us with a colostomy. She had undergone a laparotomy due to an obstructive acute abdomen a year before, and a frozen pelvis was found. Biopsy specimens had been collected and the pathological report revealed endometrioma. A rectosigmoidectomy, encompassing the stenotic rectal segment, was done along with primary anastomosis. The pathological examination confirmed rectal endometriosis. The conclusion is that, although rare, rectal endometriosis can cause significant stenosis of the organ, leading to obstructive symptoms. Despite its low frequency, it should always be considered in the differential diagnosis of rectal stenosis involving women of childbearing age. Similar content being viewed by others

References

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Intestinal Obstruction Rectal Diseases Adult Biopsy Colostomy Decompression, Surgical Diagnosis, Differential Endometriosis Endometriosis Endometriosis Female Humans Intestinal Obstruction Intestinal Obstruction Intestinal Obstruction Laparoscopy Rectal Diseases Rectal Diseases Rectal Diseases

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