The implications of the anatomy of the nerves and vessels in the treatment of rectosigmoid endometriosis

Gabriele Centini, Luca Labanca, Matteo Giorgi, Francesco Giuseppe Martire, Francesco Catania, Errico Zupi, Lucia Lazzeri
Clinical anatomy (New York, N.Y.) · 2023 · vol. 37(3) , pp. 270–277 · doi:10.1002/ca.24059 · PMID:37165994 · W4376130956
article OA: closed CC0 ⤵ 6 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-06 ⓘ

This study investigated anatomical landmarks, particularly the middle rectal artery, for precise surgical treatment of rectosigmoid endometriosis while minimizing neurovascular complications.

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Abstract

Endometriosis is a common benign gynecological disease characterized by the presence of endometrial glands and stroma outside the uterus. It can be defined as endometrioma, superficial peritoneal endometriosis or deep infiltrating endometriosis (DIE) depending on the location and the depth of infiltration of the organs. In 5%-12% of cases, DIE affects the digestive tract, frequently involving the distal part of the sigmoid colon and rectum. Surgery is generally recommended in cases of obstructive symptoms and in cases with pain that is non-responsive to medical treatment. Selection of the most optimal surgical technique for the treatment of bowel endometriosis must consider different variables, including the number of lesions, eventual multifocal lesions, as well as length, width and grade of infiltration into the bowel wall. Except for some major and widely accepted indications regarding bowel resection, established international guidelines are not clear on when to employ a more conservative approach like rectal shaving or discoid resection, and when, instead, to opt for bowel resection. Damage to the pelvic autonomic nervous system may be avoided by detection of the middle rectal artery, where its relationship with female pelvic nerve fibers allows its use as an anatomical landmark. To reduce the risk of potential vascular and nervous complications related to bowel resection, a less invasive approach such as shaving or discoid resection can be considered as potential treatment options. Additionally, the middle rectal artery can be used as a reference point in cases of upper bowel resection, where a trans mesorectal technique should be preferred to prevent devascularization and denervation of the bowel segments not affected by the disease.

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Condition tags

mesh:D004715endometriosisdie_deep_infiltratingendometriomabowel_endometriosis

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Laparoscopy Laparoscopy Laparoscopy Laparoscopy Laparoscopy Rectal Diseases Rectal Diseases Rectal Diseases Rectal Diseases Rectal Diseases Rectal Diseases Rectal Diseases Female Female

Citation neighborhood

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.

References (45)

Cited by (6)

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europepmc
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License: CC0 · commercial use OK