Abstract
Endometriosis, a condition defined by the presence of ectopic endometrium, is a disorder of increasing incidence and a significant cause of gastroenterologic distress in young women. Although clinical manifestations vary considerably depending upon the anatomic extent of disease, characteristic abdominal complaints and typical physical findings continue to be associated with misdiagnosis and delayed recognition of gastrointestinal involvement. The authors of this paper review the medical literature concerning endometriosis of the digestive tract-emphasizing modes of presentation, risk factors, diagnostic testing, complications, and therapy. Greater familiarity with the disease and heightened awareness of its sequellae are needed and prerequisite to improved medical management.
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References
Javert CT: Pathogenesis of endometriosis based on endometrial homeoplasia, direct extension, exfoliation and implantation, lymphatic and hematogenous metastasis. Cancer 2:399–410, 1949
Ranney B: Endometriosis: Pathogenesis, symptoms, and findings. Clin Obstet Gynecol 23:865–874, 1980
Ingram JM: Endometriosis.In Current Obstetrics and Gynecologic Diagnosis and Treatment. RC Benson (ed). Los Altos, Lange Medical Publications, 1984, pp 376–388
Ranney B: Endometriosis III-Complete operations. Am J Obstet Gynecol 109:1137–1144, 1971
Kistner RW: Gynecology-Principles and Practice, 2nd ed. Chicago, Yearbook Medical Publishers, 1971
Gray LA: Endometriosis. Clin Obstet Gynecol 3:472–491, 1960
Croom RD, Donovan ML, Schwesinger WH: Intestinal endometriosis. Am J Surg 148:660–667, 1984
Luciano AA, Pitkin RM: Endometriosis: Approaches to diagnosis and treatment. Surg Annu 16:297–312, 1984
Fagan CJ: Endometriosis: Clinical and roentgenographic manifestations. Radiol Clin North Am 12:109–125, 1974
Wentz AC: Endometriosis.In Novak's Textbook of Gynecology, 11th ed. HW Jones, AC Wentz, LS Burnett (eds). Baltimore, Williams & Wilkins, 1988, pp 303–327
Labay GR, Femen F: Malignant pleural endometriosis. Am J Obstet Gynecol 109:478–480, 1971
Bednoff SL, Garfinkle BM: Endometriosis of the pleura. Obstet Gynecol 26:549–551, 1965
Kovarik JL: Thoracic endometriosis with recurrent spontaneous pneumothorax. JAMA 196:595–599, 1966
Hibbard LT, Schumann WR, Goldstein GE: Thoracic endometriosis-a review and report of two cases. Am J Obstet Gynecol 140:227–232, 1981
Schlicke CP: Ectopic endometrial tissue in the thigh. JAMA 132:445–446, 1946
Gitelis S, Petasnick JP, Turner DA, Ghiselli RW, Miller AW: Endometriosis simulating a soft tissue tumor of the thigh-CT and MR evaluation. J Comput Assist Tomogr 9:573–576, 1985
Christopher F: Inguinal endometriosis. Ann Surg 86:918–920, 1927
Strasser ES, Davis RM: Extraperitoneal inguinal endometriosis. Am Surg 43:421–422, 1977
Vaisberg M: Cyclic sciatica due to endometriosis. NY State J Med 64:1983–1987, 1964
Baker GS, Parsons WR, Welch JS: Endometriosis within the sheath of the sciatic nerve. J Neurosurg 25:652–655, 1966
Forrest JS, Brooks DL: Cyclic sciatica of endometriosis. JAMA 222:117–118, 1972
Oliker AJ, Harris AE: Endometriosis of the bladder in a male patient. J Urol 106:858–859, 1971
Pinkert TC, Catlow CE, Straus R: Endometriosis of the urinary bladder in a man with prostatic carcinoma. Cancer 43:1562–1567, 1979
Schrodt GR, Alcorn MO, Ibanez J: Endometriosis of the male urinary system-a case report. J Urol 124:722–723, 1980
Meyer R: Uber entzundliche heterotope Epithelwucherungen im weiblichen Genitalgebiete und uber eine bis in die Wurzel des Mesocolon ausgedehnte benigne Wucherung des Darmepithels. Virchows Arch 195:487–537, 1909
Macafee CHG, Greer HLH: Intestinal endometriosis: A report of 29 cases: A survey of the literature. J Obstet Gynaec Br Emp 67:539–555, 1960
Williams TJ, Pratt JH: Endometriosis in 1,000 consecutive celiotomies: Incidence and management. Am J Obstet Gynecol 129:245–250, 1977
Prystowsky JB, Stryker SJ, Ujiki GT, Poticha SM: Gastrointestinal endometriosis-incidence and indications for resection. Arch Surg 123:855–858, 1988
Ridley JH: The histogenesis of endometriosis-a review of facts and fancies. Obstet Gynecol Surv 23:1–35, 1968
Sampson JA: The development of the implantation theory for the origin of peritoneal endometriosis. Am J Obstet Gynecol 40:549–558, 1940
Ranney B: Etiology, prevention and inhibition of endometriosis. Clin Obstet Gynecol 23:875–882, 1980
Molgaard CA, Golleck AL, Gresham L: Current concepts in endometriosis. West J Med 143:42–46, 1985
Ranney B: The prevention, inhibition, palliation, and treatment of endometriosis. Am J Obstet Gynecol 123:778–785, 1975
Venter PF: Endometriosis. S Afr Med J 57:895–899, 1980
Townell NH, Vanderwalt JD: Intestinal endometriosis. Postgrad Med J 60:514–517, 1984
Tedeschi LG, Masand GP: Endometriosis of the intestines-a report of seven cases. Dis Colon Rectum 14:360–365, 1971
Williams C: Endometriosis of the colon in elderly women. Ann Surg 157:975–979, 1963
Simpson JL, Elias S, Malinak LR, Buttram VC: Heritable aspects of endometriosis: I. Genetic studies. Am J Obstet Gynecol 137:327–331, 1980
Mallinak LR, Buttram VC, Elias S, Simpson JL: Heritable aspects of endometriosis: II. Clinical characteristics of familial endometriosis. Am J Obstet Gynecol 137:332–337, 1980
Chatman DL: Endometriosis and the black woman. J Reprod Med 16:303–306, 1976
Houston DE: Evidence for the risk of pelvic endometriosis by age, race and socioeconomic status. Epidemiol Rev 6:167–191, 1984
Miyazawa K: Incidence of endometriosis among Japanese women. Obstet Gynecol 48:407–409, 1976
Blaustein A: Pelvic endometriosis.In Pathology of the Female Genital Tract, 2nd ed. A Blaustein (ed). New York, Springer-Verlag, 1982, pp 464–478
Teunen A, Ooms ECM, Tytgat GNJ: Endometriosis of the small and large bowel. Neth J Med 25:142–150, 1982
Kistner RW, Siegler AM, Behmen SJ: Suggested classification for endometriosis-relation to infertility. Fertil Steril 28:1008–1010, 1977
Panganiban W, Cornog JL: Endometriosis of the intestine and vermiform appendix. Dis Colon Rectum 15:253–260, 1972
Kratzer GL, Salvati EP: Collective review of endometriosis of the colon. Am J Surg 90:866–869, 1955
Pillay SP, Harde IR: Intestinal complications of endometriosis. Br J Surg 67:677–679, 1980
Leber RE, Hume HA: Endometriosis requiring colostomy and resection: A case report and review of the literature. Am J Proctol 17:380–387, 1966
Meyers WC, Kelvin FM, Jones RS: Diagnosis and surgical treatment of colonic endometriosis. Arch Surg 114:169–175, 1979
Williams TJ: The role of surgery in the management of endometriosis. Mayo Clin Proc 50:198–203, 1975
Samper ER, Slagle GW, Hand AM: Colonic endometriosis: Its clinical spectrum. South Med J 77:912–914, 1984
Forsgren H, Lindhagen J, Melander S, Wagermark J: Colorectal endometriosis. Acta Chir Scand 149:431–435, 1983
Henriksen E: Endometriosis. Am J Surg 90:331–337, 1955
Clement PB: Perforation of the sigmoid colon during pregnancy-a rare complication of endometriosis. Br J Obstet Gynaecol 84:548–550, 1977
Floberg K, Backdahl M, Silfersward C: Postpartum perforation of the colon due to endometriosis. Acta Obstet Gynecol Scand 63:183–184, 1984
Ledley GS, Shenk IM, Heit HA: Sigmoid colon perforation due to endometriosis not associated with pregnancy. Am J Gastroenterol 83:1424–1426, 1988
Michowitz M, Lazarovici I, Hammar B, Solowiejczyki M: Endometriosis of the colon. Postgrad Med J 57:3–7, 1981
Townell NH, Vanderwalt JD, Jagger GM: Intestinal endometriosis-diagnosis and management. Br J Surg 71:629–630, 1984
Wynn TE: Endometriosis of the sigmoid colon: Massive intramural hematoma. Arch Pathol 92:24–27, 1971
Farinon AM, Vadora E: Endometriosis of the colon and rectum-an indication for preoperative colonoscopy. Endoscopy 12:136–139, 1980
Ponka JL, Brush BE, Hodgkinson CP: Colorectal endometriosis. Dis Colon Rectum 16:490–499, 1973
Elliott GB, Christensen RM, Elliott KA: Invasive endometriosis of the intestine: Report of 21 cases. Can J Surg 13:387–395, 1970
Caccese WJ, McKinley MJ, Bronzo RL, Bronson R: Endoscopic confirmation of colonic endometriosis. Gastrointest Endosc 30:191–193, 1984
McSwain B, Linn RJ, Haley RL, Franklin RH: Endometriosis of the colon: Report of 14 patients requiring partial colectomy. South Med J 67:651–658, 1974
Keane B, Arulambalam R, Cunninghame J: Endometrioma of the rectum. NZ Med J 86:16–18, 1977
Livolsi VA, Perzin KH: Endometriosis of the small intestine, producing intestinal obstruction or simulating neoplasm. Dig Dis Sci 19:100–108, 1974
Rios FW, Edwards DL, Regan JF, Schmutzer KJ: Endometriosis of the small bowel. Arch Surg 101:403–405, 1970
Aronchick CA, Brooks FP, Dyson WL, Baron R, Thompson JJ: Ileocecal endometriosis presenting with abdominal pain and gastrointestinal bleeding. Dig Dis Sci 28:566–572, 1983
Scully RE: Weekly clinicopathological exercises. N Engl J Med 316:261–268, 1987
DeJong RJ: Subserose Adenomyomatose des Dunndarms. Virchows Arch 211:141–156, 1913
Melody GF: Endometriosis causing obstruction of the ileum. Obstet Gynecol 8:468–472, 1956
Venable JH: Endometriosis of the ileum: Four cases with obstruction. Am J Obstet Gynecol 113:1054–1055, 1972
Martimbeau PW, Pratt JH, Gaffey TA: Small bowel obstruction secondary to endometriosis. Mayo Clin Proc 50:239–243, 1975
Afdal NH, Smith J, Heffernan S, Doyle JS: Acute small bowel obstruction secondary to endometriosis-two case reports and a review of the literature. Ir Med J 77:141–143, 1984
Stahl C, Grimes EM: Endometriosis of the small bowelcase reports and review of the literature. Obstet Gynecol Surv 42:131–136, 1987
Harty RF, Kaude JV: Invasive endometriosis of the terminal ileum-a cause of small bowel obstruction of obscure origin. South Med J 76:253–255, 1983
Honore LH: Endometriosis of Meckel's diverticulum associated with intestinal obstruction-a case report. Am J Proctol 31:11–12, 1980
Hon KH: Endometriosis, mucocele and regional enteritis of Meckel's diverticulum. Arch Surg 98:209–212, 1969
Langman J, Rowland R, Vernon-Roberts B: Endometriosis of the appendix. Br J Surg 68:121–124, 1981
Uohara JK, Kobara TY: Endometriosis of the appendixreport of twelve cases and review of the literature. Am J Obstet Gynecol 121:423–426, 1975
Martin LFW, Tidman MK, Jamigson MA: Appendiceal intussusception and endometriosis. J Can Assoc Radiol 31:276–277, 1980
Collins DC: A study of 50,000 specimens of the human vermiform appendix. Surg Gynecol Obstet 110:437–445, 1955
Schmidt FR, McCarthy JD: Intussusception of the appendix with endometriosis presenting as a cecal tumor. Arch Surg 103:525–527, 1971
Minvielle L, Vargas de la Cruz J: Endometriosis of the anal canal-presentation of a case. Dis Colon Rectum 11:32–35, 1968
Qualiarello J, Coppa G, Bigelow B: Isolated endometriosis in an inguinal hernia. Am J Obstet Gynecol 152:688–689, 1985
Tornquist B: Endometriosis in vaginal, vulvar and perineal scars. Acta Obstet Gynecol Scand 29:485–488, 1949
Marchevsky AM, Zimmerman MJ, Aufses AH, Weiss H: Endometrial cyst of the pancreas. Gastroenterology 86:1589–1591, 1984
Chervenak FA, Greenlee RM, Lewenstein L, Tovell HM: Massive ascites with endometriosis. Obstet Gynecol 57:379–381, 1981
Bernstein JS, Perlow V, Brenner JJ: Massive ascites due to endometriosis. Am J Dig Dis 6:1–6, 1961
Lott JV, Rubin RJ, Salvati EP, Salazar GH: Endometrioid carcinoma of the rectum arising in endometriosis-report of a case. Dis Colon Rectum 21:56–60, 1978
Young EE, Gamble CN: Primary adenocarcinoma of the rectovaginal septum arising from endometriosis-report of a case. Cancer 24:597–601, 1969
Amano S, Yamada N: Endometriod carcinoma arising from endometriosis of the sigmoid colon-a case report. Hum Pathol 12:845–848, 1981
Brooks JJ, Wheeler JE: Malignancy arising in extragonadal endometriosis-a case report and summary of the world literature. Cancer 40:3065–3073, 1977
Fishman EK, Scatarige JC, Saksouk FA, Rosenhein NB, Siegelman SS: Computed tomography of endometriosis. J Comput Assist Tomogr 7:257–264, 1983
Zawin M, McCarthy S, Scoutt L, Comite F: Endometriosis-Appearance and detection at MR imaging. Radiology 171:693–696, 1989
Butler H, Bryan PJ, LiPuma JP, Cohen AM, Yousef SE, Andriole JG, Lieberman J: Magnetic resonance imaging of the abnormal female pelvis. AJR 143:1259–1256, 1984
Morson BC: Color Atlas of Gastrointestinal Pathology. Philadelphia, WB Saunders, 1988
Karnaky KJ: Endometriosis. JAMA 157:267, 1955
Andrews WC: Medical versus surgical treatment of endometriosis. Clin Obstet Gynecol 23:917–924, 1980
Riddick DH: Drug therapy of endometriosis. Drug Ther 225–228, 1982
Kistner RW: Endometriosis and infertility. Clin Obstet Gynecol 22:101–119, 1979
Hammond CB, Rock JA, Parker RT: Conservative treatment of endometriosis-the effects of limited surgery and hormonal pseudopregnancy. Fertil Steril 27:756–766, 1976
Hamblen EC: Androgenic therapy of women. South Med J 50:743–752, 1957
Katayama KP, Manuel M, Jones HW, Jones GS: Methylt-estosterone treatment of infertility associated with pelvic endometriosis. Fertil Steril 27:83–86, 1976
Editorial: Endometriosis-continuing conundrum. Br Med J 281:889–890, 1980
Ingerslev M: Danazol-an antigonadotrophic agent in the treatment of recurrent pelvic and intestinal endometriosis. Acta Obstet Gynecol Scand 56:343–346, 1977
Lauersen NH, Wilson KH, Birnbaum S: Danazol-an antigonadotrophic agent in the treatment of pelvic endometriosis. Am J Obstet Gynecol 123:742–747, 1975
Dmowski WP, Cohen MR: Treatment of endometriosis with an antigonadotropin, danazol-a laparoscopic and histologic examination. Obstet Gynecol 46:147–154, 1975
Dmowski WP, Cohen MR: Antigonadotropin (danazol) in the treatment of endometriosis-evaluation of posttreatment fertility and three-year follow-up data. Am J Obstet Gynecol 130:41–48, 1978
Cohen MR: Laparoscopic diagnosis and pseudomenopause treatment of endometriosis with danazol. Clin Obstet Gynecol 23:901–915, 1980
Jenkinson EL, Brown WH: Endometriosis-a study of 117 cases with special reference to constricting lesions of the rectum and sigmoid colon. JAMA 122:349–354, 1943
Cattell RB: Endometriosis of the colon and rectum with intestinal obstruction. N Engl J Med 217:9–217, 1937
Boles RS, Hodes PJ: Endometriosis of the small and large intestines. Gastroenterology 34:367–380, 1958
Ingerslev M: Danazol-an antigonadotrophic agent in the treatment of recurrent pelvic and intestinal endometriosis. Acta Obstet Gynaecol Scand 56:343–346, 1977
Brzyski RG, Comite F: Nafarelin, an intranasal GnRH analog for infertility associated with endometriosis. Fertil Steril 48(suppl):72, 1987
Tummon I, Pepping P, Henig I, Radwanska E: Effectiveness of ovarian suppression with a GnRH antagonistbuserelin or danazol in the treatment of endometriosis-a comparative study. Fertil Steril 48(suppl):103, 1987
Chong AP, Baggish MS: Management of pelvic endometriosis by means of intraabdominal carbon dioxide laser. Fertil Steril 41:14–18, 1984
Henriksen E: Endometriosis. Am J Surg 90:331–337, 1955
Drossman DA, Powell DW, Sessions JT: The irritable bowel syndrome. Gastroenterology 73:811–822, 1977
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Zwas, F.R., Lyon, D.T. Endometriosis. Digest Dis Sci 36, 353–364 (1991). https://doi.org/10.1007/BF01318209
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DOI: https://doi.org/10.1007/BF01318209