Bowel endometriosis: a surgical red flag

Ketan Vagholkar, Arpit Murarka, Sandeeta Shetty, Suvarna Vagholkar
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2017 · vol. 6(10) , pp. 4193 · doi:10.18203/2320-1770.ijrcog20174094 · W2751675239
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

Bowel endometriosis presents diagnostic challenges due to varied symptoms and requires careful consideration of hormonal and surgical treatments based on clinical and radiological findings.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-08 · read from full text ⓘ

This paper reviews bowel endometriosis by focusing on how its variable symptom patterns can create diagnostic dilemmas and emphasizes the need to understand pathophysiology, clinical features, and available diagnostic modalities. It frames management around two main approaches—hormonal manipulation and surgical resection—stating that the choice should be based on critical analysis of clinical and radiological findings, with attention to fertility desires in patients with associated infertility. The paper’s main limitation is that it is not presented as a primary empirical study with new patient data, but rather as a discussion of presentation, diagnosis, and treatment considerations. This paper is centrally about endometriosis — specifically bowel endometriosis as a “surgical red flag.”

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Abstract

Endometriosis is a disease restricted usually to the female genital tract. Involvement of the bowel by this disease can lead to a diagnostic dilemma due to the great variation in the symptomatology. Awareness of the pathophysiology, clinical features and diagnostic modalities is of utmost importance to decide the modality of treatment. Hormonal manipulation and surgical resection are the two modalities of treatment. The choice depends upon critical analysis of clinical and radiological findings and the desire to have pregnancy in cases associated with infertility.
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Bowel endometriosis: a surgical red flag DOI: https://doi.org/10.18203/2320-1770.ijrcog20174094Keywords: Bowel endometriosis, Medical surgical managementAbstract Endometriosis is a disease restricted usually to the female genital tract. Involvement of the bowel by this disease can lead to a diagnostic dilemma due to the great variation in the symptomatology. Awareness of the pathophysiology, clinical features and diagnostic modalities is of utmost importance to decide the modality of treatment. Hormonal manipulation and surgical resection are the two modalities of treatment. The choice depends upon critical analysis of clinical and radiological findings and the desire to have pregnancy in cases associated with infertility. Metrics References Bianchi A, Pulido L, Espín F, Hidalgo LA, Heredia A, Fantova MJ et al. Intestinal endometriosis. Current status Cir Esp. 2007;81:170-6. Chapron C, Chopin N, Borghese B, Foulot H, Dousset B, Vacher-Lavenu MC et al. Deeply infiltrating endometriosis: pathogenetic implications of the anatomical distribution. Hum Reprod. 2006;21:1839-45. Remorgida V, Ragni N, Ferrero S, Anserini P, Torelli P, Fulcheri E. The involvement of the interstitial Cajal cells and the enteric nervous system in bowel endometriosis. Hum Reprod. 2000;20:264-271. Ferrero S, Haas S, Remorgida V, Camerini G, Fulcheri E, Ragni N et al. Loss of sympathetic nerve fibers in intestinal endometriosis. Fertil Steril. 2010;94:2817-9. Yantiss RK, Clement PB, Young RH. Endometriosis of the intestinal tract: a study of 44 cases of a disease that may cause diverse challenges in clinical and pathologic evaluation. Am J Surg Pathol. 2001;25:445-454. Jenkins S, Olive DL, Haney AF. Endometriosis:pathogenetic implications of the anatomic distribution. Obstet Gynecol. 1986;67:335-38. Chapron C, Fauconnier A, Vieira M, Barakat H, Dousset B, Pansini V et al. Anatomical distribution of deeply infiltrating endometriosis: surgical implications and proposition for a classification. Hum Reprod. 2003;18:157-161. Hudelist G, English J, Thomas AE, Tinelli A, Singer CF, Keckstein J. Diagnostic accuracy of transvaginal ultrasound for non-invasive diagnosis of bowel endometriosis: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2011;37:257-263. Abrao MS, Gonçalves MO, Dias JA Jr, Podgaec S, Chamie LP, Blasbalg R. Comparison between clinical examination, transvaginal sonography and magnetic resonance imaging for the diagnosis of deep endometriosis. Hum Reprod. 2007;22:3092-7. Goncalves MO, Podgaec S, Dias JA Jr, Gonzalez M, Abrao MS. Transvaginal ultrasonography with bowel preparation is able to predict the number of lesions and rectosigmoid layers affected in cases of deep endometriosis, defining surgical strategy. Hum Reprod. 2010;25:660-671. Bazot M, Darai E, Hourani R, Thomassin I, Cortez A, Uzan S et al. Deep pelvic endometriosis: MR imaging for diagnosis and prediction of extension of disease. Radiology. 2004;232:379-89. Remorgida V, Ferrero S, Fulcheri E, Ragni N, Martin DC. Bowel endometriosis: presentation, diagnosis, and treatment. Obstet Gynecol Surv. 2007;62:461-470. Ferrero S, Abbamonte LH, Remorgida V, Ragni N. Irritable bowel syndrome and endometriosis. Eur J Gastroenterol Hepatol. 2005;17:687. Ferrero S, Remorgida V, Venturini PL. Current pharmacotherapy for endometriosis. Expert Opin Pharmacother. 2010;11:1123-34. Porpora MG, Pallante D, Ferro A, Crobu M, Cerenzia P, Panici PL. Intestinal endometriosis without evident pelvic foci treated with gonadotropin-releasing hormone agonist. Eur J Obstet Gynecol Reprod Biol. 2006;125:260-6. Ferrero S, Camerini G, Ragni N, Venturini PL, Biscaldi E, Seracchioli R et al. Letrozole and norethisterone acetate in colorectal endometriosis. Eur J Obstet Gynecol Reprod Biol. 2010;150:199-202. Vagholkar KR. Healing of anastomoses in the gastrointestinal tract. (Retrospective study of 35 cases). Bombay Hospital J. 2001;43(2):269-279. Vagholkar KR. Postoperative adhesive intestinal obstruction. Bombay Hospital J. 1996;38(2):365-9. Daraï E, Bazot M, Rouzier R, Houry S, Dubernard G. Outcome of laparoscopic colorectal resection for endometriosis. Curr Opin Obstet Gynecol. 2007;19:308-313. Daraï E, Marpeau O, Thomassin I, Dubernard G, Barranger E, Bazot M. Fertility after laparoscopic colorectal resection for endometriosis: preliminary results. Fertil Steril. 2005;84:945-950. Ferrero S, Anserini P, Abbamonte LH, Ragni N, Camerini G, Remorgida V. Fertility after bowel resection for endometriosis. Fertil Steril. 2009;92:41-6. Donnez J, Squifflet J. Complications, pregnancy and recurrence in a prospective series of 500 patients operated on by the shaving technique for deep rectovaginal endometriotic nodules. Hum Reprod 2010;25:1949-58.

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