Skip to main content

Advertisement

SpringerLink
Log in

Laparoscopic ileocecal resection for bowel endometriosis

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Ileocecal endometriosis is a very rare entity, and its diagnosis is usually made during surgery for other endometriosis sites or, rarely, because of direct complications of ileal involvement. This study was designed to analyze perioperative and long-term outcomes after bowel resection for ileocecal endometriosis.

Methods

All patients who underwent surgery for ileocecal endometriosis between October 2004 and January 2008 were prospectively collected and analyzed.

Results

Thirty-one women (median age, 34 (range, 25–40) years) were identified. Ileocecal endometriosis was diagnosed during surgery in all patients, and it was associated with colorectal endometriosis in 29 patients (94%). All patients underwent laparoscopic ileocecal resection with no laparotomic conversion. Rectosigmoid or rectal resections was associated in 28 patients (90%) and nodulectomy for sigmoid endometriosis in 1 patient. Median duration of surgery was 301 (range, 90–480) min. Other associated surgical procedures included total hysterectomy (n = 3, 14%), ureterolysis (n = 7, 23%), excision of vesical (n = 4, 13%), vaginal (n = 8, 26%), and parametrial (n = 3, 14%) nodules. There was no mortality. Four patients (13%) required blood transfusions and one a reoperation for bleeding. In a patient who performed ureterolysis, a ureteral fistula occurred. The median hospital stay was 7 (range, 5–18) days. Long-term (>12 months) follow-up data were available for 18 patients. After a median follow-up of 27 months, in 12 of 18 patients (67%) defecation after surgery was normal. Only one patient developed recurrence, which is under medical treatment.

Conclusions

Laparoscopic ileocecal resection is safe and feasible and should be considered as part of surgery for endometriosis with radical intent.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Koninckx PR, Meuleman C, Demeyere S, Lesaffre E, Cornillie FJ (1991) Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain. Fertil Steril 55:759–765

    PubMed  CAS  Google Scholar 

  2. Ballweg ML (2004) Impact of endometriosis on women’s health: comparative historical data show that the earlier the onset, the more severe the disease. Best Pract Res Clin Obstet Gynaecol 18:201–218

    Article  PubMed  Google Scholar 

  3. Cornillie FJ, Oosterlynck D, Lauweryns JM, Koninckx PR (1990) Deeply infiltrating pelvic endometriosis: histology and clinical significance. Fertil Steril 53:978–983

    PubMed  CAS  Google Scholar 

  4. Chapron C, Jacob S, Dubuisson JB, Vieira M, Liaras E, Fauconnier A (2001) Laparoscopically assisted vaginal management of deep endometriosis infiltrating the rectovaginal septum. Acta Obstet Gynecol Scand 80:349–354

    PubMed  CAS  Google Scholar 

  5. Giudice LC, Kao LC (2004) Endometriosis. Lancet 364:1789–1799

    Article  PubMed  Google Scholar 

  6. Jenkins S, Olive DL, Haney AF (1986) Endometriosis: pathogenetic implications of the anatomic distribution. Obstet Gynecol 67:335–358

    PubMed  CAS  Google Scholar 

  7. Macafee CH, Greer HL (1960) Intestinal endometriosis. A report of 29 cases and a survey of the literature. J Obstet Gynaecol Br Emp 67:539–555

    Article  PubMed  CAS  Google Scholar 

  8. Weed JC, Ray JE (1987) Endometriosis of the bowel. Obstet Gynecol 69:727–730

    PubMed  CAS  Google Scholar 

  9. Bailey HR, Ott MT, Hartendorp P (1994) Aggressive surgical management for advanced colorectal endometriosis. Dis Colon Rectum 37:747–753

    Article  PubMed  CAS  Google Scholar 

  10. Fedele L, Bianchi S, Zanconato G, Bettoni G, Gotsch F (2004) Long-term follow-up after conservative surgery for rectovaginal endometriosis. Am J Obstet Gynecol 190:1020–1024

    Article  PubMed  Google Scholar 

  11. Remorgida V, Ferrero S, Fulcheri E, Ragni N, Martin DC (2007) Bowel endometriosis: presentation, diagnosis and treatment. Obstet Gynecol Surv 62:461–470

    Article  PubMed  Google Scholar 

  12. Minelli L, Fanfani F, Fagotti A, Ruffo G, Ceccaroni M, Mereu L, Landi S, Pomini P, Scambia G (2009) Laparoscopic colorectal resection for bowel endometriosis: feasibility, complications, and clinical outcome. Arch Surg 144:234–239

    Article  PubMed  Google Scholar 

  13. Ruffo G, Scopelliti F, Scioscia M, Ceccaroni M, Mainardi P, Minelli L (2010) Laparoscopic colorectal resection for deep infiltrating endometriosis: analysis of 436 cases. Surg Endosc 24:63–67

    Article  PubMed  Google Scholar 

  14. Stepniewska A, Pomini P, Guerriero M, Scioscia M, Ruffo G, Minelli L (2009) Colorectal endometriosis: benefits of long-term follow-up in patients who underwent laparoscopic surgery. Fertil Steril 93:2444–2446

    Article  Google Scholar 

  15. Stepniewska A, Pomini P, Bruni F, Mereu L, Ruffo G, Ceccaroni M, Scioscia M, Guerriero M, Minelli L (2009) Laparoscopic treatment of bowel endometriosis in infertile women. Hum Reprod 24:1619–1625

    Article  PubMed  CAS  Google Scholar 

  16. Stepniewska A, Pomini P, Scioscia M, Mereu L, Ruffo G, Minelli L (2010) Fertility and clinical outcome after bowel resection in infertile women with endometriosis. Reprod Biomed Online 20:602–609

    Article  PubMed  Google Scholar 

  17. Chapron C, Jacob S, Dubuisson JB, Vieira M, Liaras E, Fauconnier A (2001) Laparoscopically assisted vaginal management of deep endometriosis infiltrating the rectovaginal septum. Acta Obstet Gynecol Scand 80:349–354

    PubMed  CAS  Google Scholar 

  18. Garry R, Clayton R, Hawe J (2000) The effect of endometriosis and its radical laparoscopic excision on quality of life indicators. BJOG 107:44–54

    Article  PubMed  CAS  Google Scholar 

  19. Remorgida V, Ragni N, Ferrero S, Anserini P, Torelli P, Fulcheri E (2005) How complete is full thickness disc resection of bowel endometriotic lesions? A prospective surgical and histological study. Hum Reprod 20:2317–2320

    Article  PubMed  CAS  Google Scholar 

  20. De Ceglie A, Bilardi C, Blanchi S, Picasso M, Di Muzio M, Trimarchi A, Conio M (2008) Acute small bowel obstruction caused by endometriosis: a case report and review of the literature. World J Gastroenterol 14:3430–3434

    Article  PubMed  Google Scholar 

  21. Vanderhoof JA, Langnas AN, Pinch LW, Thompson JS, Kaufman SS (1992) Short bowel syndrome. J Pediatr Gastroenterol Nutr 14:359–370

    Article  PubMed  CAS  Google Scholar 

  22. Ret Dávalos ML, De Cicco C, D’Hoore A, De Decker B, Koninckx PR (2007) Outcome after rectum or sigmoid resection: a review for gynecologists. J Minim Invasive Gynecol 14:33–38

    Article  PubMed  Google Scholar 

  23. Darai E, Ackerman G, Bazot M, Rouzier R, Dubernard G (2007) Laparoscopic segmental resection for endometriosis: limits and complications. Surg Endosc 21:1572–1577

    Article  PubMed  CAS  Google Scholar 

  24. Landi S, Ceccaroni M, Perutelli A, Allodi C, Barbieri F, Fiaccavento A, Ruffo G, McVeigh E, Zanolla L, Minelli L (2006) Laparoscopic nerve-sparing complete excision of deep endometriosis: is it feasible? Hum Reprod 21:774–781

    Article  PubMed  CAS  Google Scholar 

  25. La Greca G, Catanuto G, Pontillo T, Sichel I, Di Carlo I, Russello D, Latteri F (2000) Ileal endometriosis. A clinical case and a review of the literature. G Chir 21:12–16

    PubMed  CAS  Google Scholar 

  26. Cirillo F, Vismarra M, Buononato M, Magnani E, Vergoni F, Martinotti M (2008) Endometriosis of the caecum and ileo-caecal valve. A case report and review of the literature. Chir Ital 60:603–606

    PubMed  Google Scholar 

  27. Denève E, Maillet O, Blanc P, Fabre JM, Nocca D (2008) Ileocecal intussusception secondary to a cecal endometriosis. J Gynecol Obstet Biol Reprod 37:796–798

    Google Scholar 

  28. Mittermair RP, Prommegger R, Zelger BG, Bodner E (1999) Intestinal invagination due to endometriosis of the terminal ileum. Dtsch Med Wochenschr 124:1522–1524

    Google Scholar 

  29. Maltz C, Sonoda T, Yantiss RK (2008) Endometriosis causing ileocecal intussusception. Gastrointest Endosc 67:35

    Article  Google Scholar 

  30. Fu CW, Zhu L, Lang JH (2007) Terminal ileum perforation: a rare complication of intestinal endometriosis. Chin Med J (Engl) 120:1381–1382

    Google Scholar 

  31. No Authors listed (1997) Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril 67:817–821

    Google Scholar 

  32. Faccioli N, Foti G, Manfredi R, Mainardi P, Spoto E, Ruffo G, Minelli L, Mucelli RP (2010) Evaluation of colonic involvement in endometriosis: double-contrast barium enema vs. magnetic resonance imaging. Abdom Imaging 35:414–421

    Article  PubMed  CAS  Google Scholar 

  33. Faccioli N, Manfredi R, Mainardi P, Dalla Chiara E, Spoto E, Minelli L, Mucelli RP (2008) Barium enema evaluation of colonic involvement in endometriosis. AJR Am J Roentgenol 190:1050–1054

    Article  PubMed  Google Scholar 

  34. Ribeiro HS, Ribeiro PA, Rossini L, Rodrigues FC, Donadio N, Aoki T (2008) Double-contrast barium enema and transrectal endoscopic ultrasonography in the diagnosis of intestinal deeply infiltrating endometriosis. J Minim Invasive Gynecol 15:315–320

    Article  PubMed  Google Scholar 

  35. Biscaldi E, Ferrero S, Fulcheri E, Ragni N, Remorgida V, Rollandi GA (2007) Multislice CT enteroclysis in the diagnosis of bowel endometriosis. Eur Radiol 17:211–219

    Article  PubMed  Google Scholar 

  36. Brown AL, Skehan SJ, Greaney T, Rawlinson J, Somers S, Stevenson GW (2001) Value of double-contrast barium enema performed immediately after incomplete colonoscopy. AJR Am J Roentgenol 176:943–945

    PubMed  CAS  Google Scholar 

  37. Roger N, Munoz-Bongrand N, Vila A, Allez M, Gornet JM, Cattan P, Lemann M, Sarfati E (2005) Exclusive ileal endometriosis. Gastroenterol Clin Biol 29:1157–1159

    Article  PubMed  Google Scholar 

  38. Koutsourelakis I, Markakis H, Koulas S, Mparmpantonakis N, Perraki E, Christodoulou K (2007) Ileocolic intussusception due to endometriosis. JSLS 11:131–135

    PubMed  Google Scholar 

  39. Chaâbouni S, Makni SK, Kallel RI, Gouiaa N, Bahri I, Mnif L, Affes N, Boudawara T (2009) Unusual cause of intestinal obstruction: ileal endometriosis. Pathologica 101:130–132

    PubMed  Google Scholar 

  40. Pickron TB, Cooper J (2009) Laparoscopic hysterectomy and ileocecal resection for treatment of endometriosis. JSLS 13:224–225

    PubMed  Google Scholar 

  41. Kalu E, Richardson R, Sellu D, Kubba F (2008) Endometriosis-associated ileo-cecal perforation in a woman on the pseudopregnancy regimen. J Minim Invasive Gynecol 15:764–766

    Article  PubMed  Google Scholar 

Download references

Disclosures

Giacomo Ruffo, Ania Stepniewska, Stefano Crippa, Giacomo Serboli, Claudio Zardini, Martin Steinkasserer, Marcello Ceccaroni, Luca Minelli, and Massimo Falconi have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Surgery, Ospedale Sacro Cuore, Via Sempreboni, 5, 37024, Negrar, VR, Italy

    Giacomo Ruffo, Stefano Crippa & Claudio Zardini

  2. Department of Gynecology, Ospedale Sacro Cuore, Negrar, Italy

    Ania Stepniewska, Giacomo Serboli, Martin Steinkasserer, Marcello Ceccaroni & Luca Minelli

  3. Department of Surgery, University of Verona, Verona, Italy

    Stefano Crippa & Massimo Falconi

Authors
  1. Giacomo Ruffo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ania Stepniewska
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stefano Crippa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giacomo Serboli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Claudio Zardini
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Martin Steinkasserer
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Marcello Ceccaroni
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Luca Minelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Massimo Falconi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Giacomo Ruffo.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ruffo, G., Stepniewska, A., Crippa, S. et al. Laparoscopic ileocecal resection for bowel endometriosis. Surg Endosc 25, 1257–1262 (2011). https://doi.org/10.1007/s00464-010-1354-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-010-1354-x

Keywords

Search

Navigation