Ileocecal endometriosis: diagnosis and treatment

А.А. Popov, К В Пучков, V.V. Troshina, Yu.I. Sopova, А.А. Fedorov, S.S. Tyurina, M. R. Ovsyannikova, I.Yu. Ershova, T.A. Glebov, S.G. Mamedova
In: Russian Bulletin of Obstetrician-Gynecologist · 2024 · vol. 24(4) , pp. 77 · doi:10.17116/rosakush20242404177 · W4401760608
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Abstract

Objective. To study the incidence of ileocecal endometriosis, the diagnostic features and course of the disease in this localization, as well as the tactics of conservative and surgical management of patients with endometriosis of the small intestine and the «right» parts of the large intestine. Materials and methods. Based on the Moscow Regional Research Institute named after. Academician V.I. Krasnopolsky and the Swiss University Clinic (New Technologies Plus LLC) are conducting a retrospective and prospective analysis of patients diagnosed with ileocecal endometriosis. The study included 104 patients from 2013 to 2024. Results. The features of the clinical course of the disease are analyzed. Patients were divided into groups depending on management and treatment tactics. The first group is a dynamic observation group, which included patients who did not undergo radical surgical treatment due to the absence of clinically significant symptoms and signs of stenosis and deformation of the intestinal lumen according to the intraoperative status the second group — patients who were subjected to radical surgical treatment with removal of the affected areas of the intestine and subsequent histological examination of the macroscopic specimen. Group I included 31 (29.8%) patients; group II included 73 (70.2%) patients. During the study, only one patient transferred from the observational group to the group of patients subjected to radical surgical treatment due to the development of clinical symptoms. Conclusion. The main problem in diagnosing this pathology is the asymptomatic nature of endometrioid lesions and infiltrates of the small intestine and right side of the colon during a long period of disease progression. According to our data, the most common symptoms of endometriosis of the right side are: pain in the right iliac region, flatulence associated with menstruation and nausea and vomiting during menstruation. Ileocecal endometriosis is not always accessible for visualization using ultrasound and MRI; it is necessary to include the study of the right iliac region in the standard protocol in patients with suspected infiltrative endometriosis, as well as in the presence of bilateral endometriomas of any size. It is important to conduct a thorough examination of the abdominal organs, including the ileocecal region, when performing surgical treatment in patients with various phenotypes of endometriosis.

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endometriosis

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