Intestinal endometriosis: presentation, investigation, and surgical management

  • I. C. Cameron
  • S. Rogers
  • M. C. Collins
  • M. W. R. Reed
Original Articles

Abstract

The study was undertaken to identify the presenting features of intestinal endometriosis and to evaluate its investigation and surgical management. Twenty-six cases of intestinal endometriosis were identified during a fourteen year period. The commonest site of occurrence was the rectosigmoid region (11 cases) followed by the appendix (9 cases), and ileocaecal region (6 cases). Abdominal pain was the main presenting feature in 20 cases, with associated nausea and vomiting in 12 cases and altered bowel habit in ten. Other presenting features included rectal bleeding, abdominal bloating and tenesmus. Endometriosis was not suspected preoperatively in any of the patients without a past history of this condition. Accurate preoperative diagnosis proved very difficult, with only laparoscopy providing definite evidence of intestinal endometriosis prior to formal surgery. Colonic resections were performed in 12 cases, small bowel resection in six cases and appendicectomy in nine cases, together with resection of adjacent adherent structures. This series illustrates the difficulty of establishing an accurate preoperative diagnosis, and the propensity of intestinal endometriosis to mimic other gastrointestinal diseases, particularly carcinoma and inflammatory bowel disease.

Résumé

Cette étude a été entreprise afin d'identifier les manifestations cliniques d'une endométriose intestinale et d'évaluer les modes d'investigation et le traitement chirurgical. Vingt-six cas d'endométriose intestinale ont été identifiés au cours d'une période de 14 ans. Le lieu le plus fréquent de développement de l'endométriose est la région recto-sigmïdienne (11 cas) suivie de l'appendice (9 cas) et de la région iléocaecale (6 cas). La douleur abdominale constitue la manifestation la plus importante chez 20 patients et est associée des nausées et des vomissements chez 12 patients ainsi que des altérations du transit chez 10 patients. D'autres manifestations sont constituées par le saignement rectal, le ballonnement abdominal et des ténesmes. L'endométriose n'a jamais été suspectée en pré-opératoire chez aucun des patients qui ne comportait pas d'anamnèse de cette affection. Un diagnostic précis pré-opératoire est très difficile; seule la laparoscopie permet d'affirmer le diagnostic d'endométriose intestinale avant une chirurgie d'exérèse. Des résections coliques ont été réalisées chez 12 patients; des résections de l'intestion grêle chez 6, une appendicectomie chez 9 en association à des excisions des tissus adhérents adjacents. Cette série illustre les difficultés dans l'établissement d'un diagnostic pré-opératoire précise et la tendance de l'endométriose intestinale à mimer d'autres affections digestives, en particulier le cancer et les maladies inflammatoires de l'intestin.

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References

  1. 1.
    Graham B, Mazier WP (1988) Diagnosis and management of endometriosis of the colon and rectum. Dis Colon Rectum 31: 952–956Google Scholar
  2. 2.
    Weed JC, Ray JE (1987) Endometriosis of the bowel. Obstet Gynecol 69:727–730Google Scholar
  3. 3.
    MacAffee CHG, Greer HLH (1960) Intestinal endometriosis: A report of 29 cases and a survey of the literature. J Obstet Gynaecol of the British Empire 67:539–555Google Scholar
  4. 4.
    Gray LA (1973) Endometriosis of the bowel: role of bowel resection, superficial excision and oophorectomy in treatment. Ann Surg 177:580–587Google Scholar
  5. 5.
    Croom RD, Donovan ML, Schwesinger WH (1984) Intestinal endometriosis. Am J Surg 148:660–667Google Scholar
  6. 6.
    Henrickson E (1955) Endometriosis. Am J Surg 90:331–337Google Scholar
  7. 7.
    Meyers WC, Kelvin FM, Jones RS (1979) Diagnosis and surgical treatment of colonic endometriosis. Arch Surg 114:169–175Google Scholar
  8. 8.
    Bermann W, Heuer C (1992) Extragenital endometriosis with multiple stenoses of the small intestine. Fortschr Med 110: 281–284Google Scholar
  9. 9.
    Nikapota VLB (1980) Endometriosis of the caecum causing intussusception. Br J Radiol 53:599–602Google Scholar
  10. 10.
    Lane RE (1960) Endometriosis of the vermiform appendix. Am J Obstet Gynecol 79:372–377Google Scholar
  11. 11.
    Langman J, Rowland R, Vernon-Roberts B (1981) Endometriosis of the appendix. Br J Surg 68:121–124Google Scholar
  12. 12.
    Mittall VK, Choudhury SP, Cortez JA (1981) Endometriosis of the appendix presenting as acute appendicitis. Am J Surg 142: 519–521Google Scholar
  13. 13.
    Desanto DA, McBirnie JE (1949) Endometriosis: A clinical and pathological study of 219 cases. Calif Med 71:274–279Google Scholar
  14. 14.
    Burns FJ (1967) Endometriosis of the intestine. Dis Colon Rectum 10:344Google Scholar
  15. 15.
    Kistner RW, Siegler AN, Bahman SG (1977) Suggested classification for endometriosis: relationship to infertility. Fertil Steril 28:1008–1010Google Scholar
  16. 16.
    Townell NH, Vanderwalt JD, Jagger GM (1984) Intestinal endometriosis: Diagnosis and management. Br J Surg 71:629–630Google Scholar
  17. 17.
    Dmowski WP (1981) Current concepts in the management of endometriosis. Ann Obstet Gynecol 21:56–60Google Scholar
  18. 18.
    Lott JV, Rubin RJ, Salvati EP, Salazar GH (1978) Endometrioid carcinoma of the rectum arising in endometriosis: report of a case. Dis Colon Rectum 21:56–60Google Scholar

Copyright information

© Springer-Verlag 1995

Authors and Affiliations

  • I. C. Cameron
    • 1
  • S. Rogers
    • 2
  • M. C. Collins
    • 3
  • M. W. R. Reed
    • 1
  1. 1.Department of SurgeryRoyal Hallamshire HospitalSheffieldUK
  2. 2.Department of PathologyRoyal Hallamshire HospitalSheffieldUK
  3. 3.Department of RadiologyRoyal Hallamshire HospitalSheffieldUK

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