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Editorial
. 2011 Mar 27;3(3):31-38.
doi: 10.4240/wjgs.v3.i3.31.

Bowel endometriosis: Recent insights and unsolved problems

Simone Ferrero  1   2   3 , Giovanni Camerini  1   2   3 , Umberto Leone Roberti Maggiore  1   2   3 , Pier L Venturini  1   2   3 , Ennio Biscaldi  1   2   3 , Valentino Remorgida  1   2   3
Affiliations
Editorial

Bowel endometriosis: Recent insights and unsolved problems

Simone Ferrero et al. World J Gastrointest Surg. .

Abstract

Bowel endometriosis affects between 3.8% and 37% of women with endometriosis. The evaluation of symptoms and clinical examination are inadequate for an accurate diagnosis of intestinal endometriosis. Transvaginal ultrasonography is the first line investigation in patients with suspected bowel endometriosis and allows accurate determination of the presence of the disease. Radiological techniques (such as magnetic resonance imaging and multidetector computerized tomography enteroclysis) are useful for estimating the extent of bowel endometriosis. Hormonal therapies (progestins, gonadotropin releasing hormone analogues and aromatase inhibitors) significantly improve pain and intestinal symptoms in patients with bowel stenosis less than 60% and who do not wish to conceive. However, hormonal therapies may not prevent the progression of bowel endometriosis and, therefore, patients receiving long-term treatment should be periodically monitored. Surgical excision of bowel endometriosis should be offered to symptomatic patients with bowel stenosis greater than 60%. Intestinal endometriotic nodules may be excised by nodulectomy or segmental resection. Both surgical procedures improve pain, intestinal symptoms and fertility. Nodulectomy may be associated with a lower rate of complications.

Keywords: Bowel endometriosis; Colorectal resection; Diagnosis; Endometriosis; Gonadotropin releasing hormone analogue; Laparoscopy; Nodulectomy; Progestin.

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Figures

Figure 1
Figure 1
Section of a bowel endometriotic nodule, hemeatoxylin eosin staining demonstrates the nodule infiltrate the mucosa.
Figure 2
Figure 2
Sections of an intestinal endometriotic nodule demonstrating the thickening of the bowel wall caused by the endometriotic nodule.
Figure 3
Figure 3
Magnetic resonance imaging, T2W sagittal image. A nodule infiltrating the rectum is well detectable (arrow). Enhancement of the nodule is observed after injection of iodinated contrast medium.
Figure 4
Figure 4
Magnetic resonance imaging enteroclysis. The rectosigmoid is distended by using 250-300 mL of ultrasonographic gel diluted with saline solution; the 20-Fr Foley catheter used for retrograde distension can be observed in the figure. The fluid solution has a biphasic behavior on MR sequences: hypointense in T1W images and hyperintense in T2W images. A small rectovaginal endometriotic nodule (larger diameter 12 mm) is observed (arrow).
Figure 5
Figure 5
Multidetector computerized tomography enteroclysis, coronal reconstruction. Endometriotic nodule infiltrating the muscularis propria of the sigmoid (shown by the arrowheads); the mucosa is not infiltrated.
Figure 6
Figure 6
Multidetector computerized tomography enteroclysis, the arrow shows an endometriotic nodule infiltrating the ileum.
Figure 7
Figure 7
Nodulectomy, the endometriotic nodule is shown by the asterisk.
Figure 8
Figure 8
A mechanic circular stapler inserted transrectally is used to perform an end-to-end anastomosis.
See this image and copyright information in PMC

References

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