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coloproctology

, Volume 39, Issue 2, pp 121–133 | Cite as

Endometriose im Intestinaltrakt

Wissenswertes für Diagnose und Therapie
  • J. KecksteinEmail author
CME

Zusammenfassung

Einleitung

Die gastrointestinale Endometriose ist eine leider häufig nicht rechtzeitig und korrekt diagnostizierte Form der Endometriose. Das Auftreten von menstruationsabhängigen gastrointestinalen Beschwerden muss durch eine komplexe, ggf. auch interdisziplinäre, Diagnostik abgeklärt werden.

Methoden

Die unterschiedliche Lokalisation der Herde und Symptomatik der Endometrioseherde im Gastrointestinaltrakt in Kombination mit der geringen Sensitivität der Koloskopie erschweren eine korrekte Diagnostik. Die transvaginale Sonographie, ggf. in Kombination mit MRT und einer diagnostisch-operativen Laparoskopie, ist als Goldstandard anzusehen. Die Wahl der Therapie erfolgt immer symptomorientiert. Neben der hormonellen Therapie, die nur symptomatisch wirkt, stellt die chirurgische Entfernung das wichtigste Verfahren zur Behandlung der Herde dar. Die Abwägung zwischen Symptomatik und Risiko der Therapie ist individuell abzuwägen.

Schlussfolgerung

Ein besseres Wissen über die Charakteristik der Erkrankung, Lokalisation der gastrointestinalen Herde und deren Diagnostik, insbesondere auch bei Gastroenterologen und Chirurgen, führt zu einer früheren Diagnose der Erkrankung und rechtzeitigen Einleitung der notwendigen Therapie.

Schlüsselwörter

Endometriose Gastrointestinaltrakt Klassifikation Transvaginale Sonographie Interdisziplinäre Therapie 

Endometriosis in the intestinal tract

Important facts for diagnosis and therapy

Abstract

Introduction

Gastrointestinal endometriosis is a form of endometriosis that is often neither correctly diagnosed nor in a timely manner. The occurrence of menstruation-dependent gastrointestinal complaints must be clarified by a complex and sometimes interdisciplinary diagnostic approach.

Methods

The different localizations of lesions and the different symptoms of endometriosis in the gastrointestinal tract in combination with the low sensitivity of colonoscopy make the diagnosis difficult. Transvaginal ultrasonography in combination with magnetic resonance imaging (MRI) and laparoscopy is the gold standard of diagnostic procedures. The choice of therapy is always symptom oriented. In addition to hormone therapy, which is only symptom oriented, surgical resection represents the most important procedure for treatment of lesions. The weighing up between symptoms, clinical findings of the disease and the risk of the therapy should always be carried out on an individual basis.

Conclusion

A better knowledge of the characteristics of the disease, localization of the gastrointestinal lesions and the diagnostics, especially for gynecologists, gastroenterologists and surgeons, leads to a much earlier diagnosis of the disease and timely initiation of the necessary therapy.

Keywords

Endometriosis Gastrointestinal tract Classification Transvaginal sonography Interdisciplinary therapy 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

J. Keckstein gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine vom Autor durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Rokitansky K (1860) Ueber Uterusdruesen-Neubildung. Z Ges Ärzte Wien 16:577–581Google Scholar
  2. 2.
    Cullen TS (1896) Adeno-Myoma uteri diffusum benignum. Johns Hopkins Hosp Reports 6:133–157Google Scholar
  3. 3.
    Sampson J (1927) Peritoneal endometriosis due to menstrual dissemination of endometrial tissue into the peritoneal cavity. Am J Obstet Gynecol 14:422–469CrossRefGoogle Scholar
  4. 4.
    Leyendecker G, Kunz G, Wildt L, Beil D, Deininger H (1996) Uterine hyperperistalsis and dysperistalsis as dysfunctions of the mechanism of rapid sperm transport in patients with endometriosis and infertility. Hum Reprod 11:1542–1551CrossRefPubMedGoogle Scholar
  5. 5.
    Koninckx P, Meuleman C, Demeyere S, Lesaffe E, Cornillie F (1991) Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain. Fertil Steril 56:590–591CrossRefGoogle Scholar
  6. 6.
    Tuttlies F, Keckstein J, Ulrich U et al (2005) ENZIAN-Score, eine Klassifikation der tief infiltrierenden Endometriose. Zentralbl Gynakol 127:273–279CrossRefGoogle Scholar
  7. 7.
    Roman H, Ness J, Suciu N et al (2012) Are digestive symptoms in women presenting with pelvic endometriosis specific to lesion localizations? A preliminary prospective study. Hum Reprod 27:3440–3449CrossRefPubMedGoogle Scholar
  8. 8.
    Roman H, Bridoux V, Tuech JJ et al (2013) Bowel dysfunction before and after surgery for endometriosis. Am J Obstet Gynecol 209:524–530CrossRefPubMedGoogle Scholar
  9. 9.
    Abrao MS, Dias JA Jr., Rodini GP, Podgaec S, Bassi MA, Averbach M (2010) Endometriosis at several sites, cyclic bowel symptoms, and the likelihood of the appendix being affected. Fertil Steril 94:1099–1101CrossRefPubMedGoogle Scholar
  10. 10.
    Roman H, Hennetier C, Darwish B et al (2016) Bowel occult microscopic endometriosis in resection margins in deep colorectal endometriosis specimens has no impact on short-term postoperative outcomes. Fertil Steril 105:423–429.e7CrossRefPubMedGoogle Scholar
  11. 11.
    Remorgida V, Ferrero S, Fulcheri E, Ragni N, Martin DC (2007) Bowel endometriosis: presentation, diagnosis, and treatment. Obstet Gynecol Surv 62:461–470CrossRefPubMedGoogle Scholar
  12. 12.
    Roman H, Puscasiu L, Lempicki M et al (2015) Colorectal endometriosis responsible for bowel occlusion or subocclusion in women with pregnancy intention: Is the policy of primary in vitro fertilization always safe? J Minim Invasive Gynecol 22:1059–1067CrossRefPubMedGoogle Scholar
  13. 13.
    Torralba-Moron A, Urbanowicz M, Ibarrola-De Andres C, Lopez-Alonso G, Colina-Ruizdelgado F, Guerra-Vales JM (2016) Acute small bowel obstruction and small bowel perforation as a clinical debut of intestinal endometriosis: a report of four cases and review of the literature. Intern Med 55:2595–2599CrossRefPubMedGoogle Scholar
  14. 14.
    Fu CW, Zhu L, Lang JH (2007) Terminal ileum perforation: a rare complication of intestinal endometriosis. Chin Med J (Engl) 120:1381–1382Google Scholar
  15. 15.
    Shaw A, Lund JN, Semeraro D, Cartmill M, Reynolds JR, Tierney GM (2008) Large bowel obstruction and perforation secondary to endometriosis complicated by a ventriculoperitoneal shunt. Colorectal Dis 10:520–521CrossRefPubMedGoogle Scholar
  16. 16.
    Decker D, Konig J, Wardelmann E et al (2004) Terminal ileitis with sealed perforation – a rare complication of intestinal endometriosis: case report and short review of the literature. Arch Gynecol Obstet 269:294–298CrossRefPubMedGoogle Scholar
  17. 17.
    Milone M, Mollo A, Musella M et al (2015) Role of colonoscopy in the diagnostic work-up of bowel endometriosis. World J Gastroenterol 21:4997–5001CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Samet JD, Horton KM, Fishman EK, Hruban RH (2009) Colonic endometriosis mimicking colon cancer on a virtual colonoscopy study: a potential pitfall in diagnosis. Case Rep Med 2009:379578PubMedPubMedCentralGoogle Scholar
  19. 19.
    Hudelist G, Keckstein J (2009) The use of transvaginal sonography (TVS) for preoperative diagnosis of pelvic endometriosis. Praxis (Bern 1994) 98:603–607CrossRefGoogle Scholar
  20. 20.
    Hudelist G, English J, Thomas AE, Tinelli A, Singer CF, Keckstein J (2011) Diagnostic accuracy of transvaginal ultrasound for non-invasive diagnosis of bowel endometriosis: systematic review and meta-analysis. Ultrasound Obstet Gynecol 37:257–263CrossRefPubMedGoogle Scholar
  21. 21.
    Hudelist G, Fritzer N, Staettner S et al (2013) Uterine sliding sign: a simple sonographic predictor for presence of deep infiltrating endometriosis of the rectum. Ultrasound Obstet Gynecol 41:692–695CrossRefPubMedGoogle Scholar
  22. 22.
    Trippia CH, Zomer MT, Terazaki CR, Martin RL, Ribeiro R, Kondo W (2016) Relevance of imaging examinations in the surgical planning of patients with bowel endometriosis. Clin Med Insights Reprod Health 10:1–8PubMedPubMedCentralGoogle Scholar
  23. 23.
    Gauche Cazalis C, Koskas M, Martin B, Palazzo L, Madelenat P, Yazbeck C (2012) Preoperative imaging of deeply infiltrating endometriosis in: transvaginal sonography, rectal endoscopic sonography and magnetic resonance imaging. Gynecol Obstet Fertil 40:634–641CrossRefPubMedGoogle Scholar
  24. 24.
    Di Paola V, Manfredi R, Castelli F, Negrelli R, Mehrabi S, Pozzi Mucelli R (2015) Detection and localization of deep endometriosis by means of MRI and correlation with the ENZIAN score. Eur J Radiol 84:568–574CrossRefPubMedGoogle Scholar
  25. 25.
    Rousset P, Peyron N, Charlot M et al (2014) Bowel endometriosis: preoperative diagnostic accuracy of 3.0-T MR enterography – initial results. Radiology 273:117–124CrossRefPubMedGoogle Scholar
  26. 26.
    Roman H, Carilho J, Da Costa C et al (2016) Computed tomography-based virtual colonoscopy in the assessment of bowel endometriosis: the surgeon’s point of view. Gynecol Obstet Fertil 44:3–10CrossRefPubMedGoogle Scholar
  27. 27.
    Ferrero S, Camerini G, Ragni N, Menada MV, Venturini PL, Remorgida V (2010) Triptorelin improves intestinal symptoms among patients with colorectal endometriosis. Int J Gynaecol Obstet 108:250–251CrossRefPubMedGoogle Scholar
  28. 28.
    Nezhat C, Pennington E, Nezhat C, Ambroze W (1994) Laparoscopic disk excision and primary repair of the anterior rectal wall for the treatment of full-thickness bowel endometriosis. Surg Endosc 8:682–685CrossRefPubMedGoogle Scholar
  29. 29.
    Keckstein J, Ulrich U, Kandolf O, Wiesinger H, Wustlich M (2003) Die laparoskopische Therapie der Darmendometriose und der Stellenwert der medikamentösen Therapie. Zentralbl Gynakol 125:259–266CrossRefPubMedGoogle Scholar
  30. 30.
    Keckstein J, Wiesinger H (2005) Deep endometriosis, including intestinal involvement – the interdisciplinary approach. Minim Invasive Ther Allied Technol 14(3):160–166CrossRefPubMedGoogle Scholar
  31. 31.
    Abrao MS, Petraglia F, Falcone T, Keckstein J, Osuga Y, Chapron C (2015) Deep endometriosis infiltrating the recto-sigmoid: critical factors to consider before management. Hum Reprod Update 21:329–339CrossRefPubMedGoogle Scholar
  32. 32.
    Vanhie A, Meuleman C, Tomassetti C et al (2016) Consensus on Recording Deep Endometriosis Surgery: the CORDES statement. Hum Reprod 31(6):1219–1223. doi: 10.1093/humrep/dew067 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag Berlin 2017

Authors and Affiliations

  1. 1.EndometriosezentrumVillachÖsterreich

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