Colorectal Endometriosis Responsible for Bowel Occlusion or Subocclusion in Women With Pregnancy Intention: Is the Policy of Primary in Vitro Fertilization Always Safe?

Horace Roman, Puscasiu L, Lucian Pușcașiu, Lucian Puscasiu, Marta Lempicki, Lempicki M, Huet E, Emmanuel Huet, Rachid Chati, Chati R, Bridoux V, Valérie Bridoux, Jean‐Jacques Tuech, Jean-Jacques Tuech, Tuech JJ, Carole Abo, Abo C
Journal of Minimally Invasive Gynecology · 2015 · vol. 22(6) , pp. 1059–1067 · doi:10.1016/j.jmig.2015.05.023 · PMID:26070728 · W1567718653
article OA: closed CC0 ⤵ 31 in-corpus citations
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This paper investigates colorectal endometriosis as a cause of bowel occlusion or subocclusion in women desiring pregnancy and questions the safety of prioritizing in vitro fertilization as a management strategy.

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Abstract

ObjectiveTo discuss the risk of bowel occlusion or subocclusion in patients with pregnancy wish and deep colorectal endometriosis, when surgery is postponed until after conception.DesignA prospective series of consecutive patients managed for occlusion or subocclusion between January 2012 and January 2015 (Canadian Task Force classification II-2). Deep endometriosis had previously been diagnosed in all patients; however, they were advised to postpone surgery until after conception.SettingUniversity tertiary referral center.PatientsTwelve women with bowel occlusion or subocclusion due to deep endometriosis and desiring pregnancy.InterventionSurgical management including colorectal resection.Main outcome measuresDigestive symptoms, including standardized gastrointestinal questionnaires and preoperative imaging assessment of deep endometriosis.ResultsThe patients enrolled in the series represent 5% of 241 patients with colorectal endometriosis managed over 37 consecutive months. Major digestive complaints were bloating, defecation pain, constipation, liquid stools, and a feeling of incomplete stool evacuation. The median length of digestive tract stenosis was 50 mm (range, 20-100 mm). In 8 patients (67%), computed tomography-based virtual colonoscopy revealed a virtual digestive lumen. The median length of colorectal specimen removed was 120 mm (range, 60-200 mm). Three patients (25%) had Clavien-Dindo IIIb and IVa postoperative complications with favorable outcomes within up to 20 days after surgery.ConclusionGiven the risk of bowel occlusion or subocclusion in young patients with colorectal endometriosis, an exhaustive assessment of deep disease and advice at a tertiary referral center appears to be mandatory before prioritizing primary in vitro fertilization instead of primary surgery.

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Condition tags

endometriosis

MeSH descriptors

Colonic Diseases Digestive System Surgical Procedures Endometriosis Fertilization in Vitro Postoperative Complications Preconception Care Rectal Diseases Adult Colonic Diseases Colonic Diseases Colonic Diseases Digestive System Surgical Procedures Endometriosis Endometriosis Endometriosis Female Fertilization in Vitro Humans Intention Middle Aged

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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.

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License: CC0 · commercial use OK