Symptomatic Intestinal Endometriosis Requiring Surgical Resection: Clinical Presentation and Preoperative Diagnosis

Lia C Kaufman, Lia Kaufman, Thomas C Smyrk, Michael J Levy, Felicity T Enders, Felicity Enders, Amy S Oxentenko
The American journal of gastroenterology · 2011 · vol. 106(7) , pp. 1325–1332 · doi:10.1038/ajg.2011.66 · PMID:21502995 · W2044835055
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Abstract

OBJECTIVES: Intestinal endometriosis (IE) can present with varied symptoms, making the diagnosis difficult. Modalities have been described to evaluate IE, but few can provide a confirmatory diagnosis. A preoperative diagnosis of IE may help guide management. We sought to describe the presentation, diagnostic evaluation, histology and operative management of 89 patients with tissue-confirmed symptomatic IE. METHODS: The records of 89 patients from a single institution with histologically confirmed, symptomatic IE from 1 January 1994 to 30 September 2009 were reviewed. RESULTS: Abdominal pain was the most common symptom in patients with IE; however, rectal bleeding was significantly associated with IE of the distal colon (P=0.02), while dysfunctional uterine bleeding was seen more in patients with proximal IE (P=0.01). Preoperative confirmation of IE was uncommon; colonoscopy with biopsy confirmed the diagnosis in 29.6% of patients tested and only 15% of patients with IE had histologic lesions involving mucosa. In the five patients who underwent endoscopic ultrasound (EUS), the diagnosis of IE was established in all cases (n=4) where histology or cytology was obtained. Malignancy was considered nearly as frequently as IE preoperatively, and 90.4% of patients underwent laparotomy as the initial surgical approach. CONCLUSIONS: IE can present with a variety of manifestations, which may provide clues to location of bowel affected. Patients with known pelvic endometriosis and rectal bleeding are more likely to have distal bowel affected; EUS with tissue sampling may play a role if routine endoscopy fails to reveal the diagnosis. Making a diagnosis of IE preoperatively may allow for less invasive surgical approaches and better patient outcomes.

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Condition tags

mesh:D004715endometriosis

MeSH descriptors

Endometriosis Endometriosis Intestinal Diseases Intestinal Diseases Ultrasonography, Interventional Adult Aged Aged, 80 and over Biopsy Biopsy, Fine-Needle Diagnosis, Differential Endometriosis Endometriosis Endometriosis Female Humans Intestinal Diseases Intestinal Diseases Intestinal Diseases Middle Aged

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