Diseases of the Colon & Rectum

, Volume 41, Issue 9, pp 1158–1164 | Cite as

Bowel resection for intestinal endometriosis

  • David R. Urbach
  • Michael Reedijk
  • Carole S. Richard
  • Kay I. Lie
  • Theodore M. Ross
Original Contributions


PURPOSE: The study contained herein was undertaken to evaluate which factors predict a good outcome following intestinal resection for endometriosis. METHODS: A retrospective analysis of all patients undergoing bowel resection for severe (American Fertility Society Stage IV) endometriosis at one institution between the years 1992 and 1996 was conducted using systematic chart review and follow-up by telephone interview. RESULTS: Twenty-nine patients were identified within the study period. The most frequent symptoms were pelvic pain, abdominal pain, rectal pain, and dysmenorrhea. Nearly all patients (93 percent) underwent low anterior resection of the rectum and distal sigmoid. Other intestinal procedures were appendectomy, terminal ileal resection, cecectomy, and sigmoid resection. Thirty-four percent of patients had simultaneous total abdominal hysterectomy and bilateral salpingooophorectomy. Complete follow-up was obtained on 26 patients (90 percent; mean follow-up 22.6 (range, 8–63) months). All patients (100 percent) reported subjective improvement. Forty-six percent of patients were “cured” according to the prospectively applied definition (resolution of symptoms without need for further medical or surgical therapy). The only variable analyzed that was associated with “cure” was concomitant total abdominal hysterectomy and bilateral salpingooophorectomy (odds ratio, 12; 95 percent confidence interval, 1.8–81.7). This association remained significant after correcting for age and the presence of gastrointestinal symptoms. CONCLUSION: Intestinal resection can be performed safely in most women with severe endometriosis and bowel involvement, although many of these patients experience persistent or recurrent symptoms. Total abdominal hysterectomy and bilateral salpingooophorectomy at the time of bowel resection correlates with improved outcome.

Key words

Endometriosis Colon Rectum Hysterectomy Retrospective studies 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Lu PY, Ory SJ. Endometriosis: current management. Mayo Clin Proc 1995;70:453–63.Google Scholar
  2. 2.
    Prystowsky JB, Stryker SJ, Ujiki GT, Poitcha SM. Gastrointestinal endometriosis: incidence and indications for resection. Arch Surg 1988;123:855–8.PubMedGoogle Scholar
  3. 3.
    Meyers WC, Kelvin FM, Jones RS. Diagnosis and surgical treatment of colonic endometriosis. Arch Surg 1979;114:169–75.PubMedGoogle Scholar
  4. 4.
    Weed JC, Ray JF. Endometriosis of the bowel. Obstet Gynecol 1987;69:727–30.PubMedGoogle Scholar
  5. 5.
    Graham B, Mazier WP. Diagnosis and management of endometriosis of the colon and rectum. Dis Colon Rectum 1988;31:952–6.PubMedGoogle Scholar
  6. 6.
    Parr NJ, Murphy C, Holt S, Zakhour H, Crosbie RB. Endometriosis and the gut. Gut 1988;29:1112–5.PubMedGoogle Scholar
  7. 7.
    Coronado C, Franklin RR, Lotze EC, Bailey HR, Valdes CT. Surgical treatment of symptomatic colorectal endometriosis. Fertil Steril 1990;53:411–6.PubMedGoogle Scholar
  8. 8.
    Sharpe DR, Redwine DS. Laparascopic segmental resection of the sigmoid and rectosigmoid colon for endometriosis. Surg Laparosc Endosc 1992;2:120–4.PubMedGoogle Scholar
  9. 9.
    Cameron IC, Rogers S, Collins MC, Reed MW. Intestinal endometriosis: presentation, investigation and surgical management. Int J Colorectal Dis 1995;10:83–6.CrossRefGoogle Scholar
  10. 10.
    Redwine DB, Koning M, Sharpe DR. Laparascopically assisted transvaginal segmental resection of the rectosigmoid colon for endometriosis. Fertil Steril 1996;65:193–7.PubMedGoogle Scholar
  11. 11.
    Severt W, Sellin JH, Stringer CA. Pelvic endometriosis simulating colonic malignant neoplasm. Arch Intern Med 1989;149:935–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Anonymous. Case records of the Massachusetts General Hospital, Case 28-1996: a 45 year old woman with abdominal pain and a polypoid mass in the colon. N Engl J Med 1996;335:807–12.Google Scholar
  13. 13.
    Olive DL, Schwartz LB. Endometriosis. N Engl J Med 1993;328:1759–69.CrossRefPubMedGoogle Scholar
  14. 14.
    Dimowski WP. Current concepts in the management of endometriosis. Ann Obstet Gynecol 1981;21:56–60.Google Scholar
  15. 15.
    Nezhat C, Hood J, Winer W, Nexhat F, Crowgey SR, Garrison CP. Videolaseroscopy and laser laparoscopy in gynaecology. Br J Hosp Med 1987;38:219–24.PubMedGoogle Scholar
  16. 16.
    Redwine DB. Treatment of endometriosis-associated pain. Infertil Reprod Med Clin North Am 1993;3:697–721.Google Scholar
  17. 17.
    Gordts S, Boeckx W, Brosens I. Microsurgery of endometriosis in infertile patients. Fertil Steril 1984;42:520–5.PubMedGoogle Scholar
  18. 18.
    Kempers RD, Dockerty MB, Hunt AB, Symmonds RE. Significant postmenopausal endometriosis. Surg Gynecol Obstet 1960;111:348–56.PubMedGoogle Scholar
  19. 19.
    Bailey HR, Ott MT, Hartendorp P. Aggressive surgical management for advanced colorectal endometriosis. Dis Colon Rectum 1994;37:747–53.CrossRefPubMedGoogle Scholar
  20. 20.
    Beecher HK. Surgery as placebo. JAMA 1961;176:1102–7.PubMedGoogle Scholar
  21. 21.
    Peters AA, Trimbos-Kemper GC, Admiraal C, Trimbos JB. A randomized clinical trial on the benefit of adhesiolysis in patients with intraperitoneal adhesions and chronic pelvic pain. Br J Obstet Gynecol 1992;99:59–62.Google Scholar
  22. 22.
    Koninckx PR. Is mild endometriosis a condition occuring intermittently in all women? Hum Reprod 1994;9:2202–5.PubMedGoogle Scholar
  23. 23.
    Evers JL. Endometriosis does not exist: all women have endometriosis. Hum Reprod 1994;9:2206–9.PubMedGoogle Scholar

Copyright information

© American Society of Colon and Rectal Surgeons 1998

Authors and Affiliations

  • David R. Urbach
    • 1
    • 3
  • Michael Reedijk
    • 1
  • Carole S. Richard
    • 1
  • Kay I. Lie
    • 2
  • Theodore M. Ross
    • 1
  1. 1.From the Department of SurgeryWomen's College HospitalCanada
  2. 2.From the Department of Obstetrics and GynecologyWomen's College HospitalCanada
  3. 3.Clinical Epidemiology and Health Care Research ProgramUniversity of TorontoTorontoCanada

Personalised recommendations