[Intestinal endometriosis. Three new cases and review of the literature].
OBJECTIVE
The study was undertaken to identify some features of the intestinal endometriosis such as symptoms, helpful investigations, pattern of distribution and surgical management.


METHODS
Three consecutive cases, observed during a sixteen month period, are reported. The most frequent symptoms were chronic pelvic and abdominal pain, dysmenorrhea, alterated bowel habit and menorrhagia. The diagnosis of intestinal endometriosis was incidental in all but one case admitted for an intestinal subocclusive syndrome in patient with a past history of pelvic endometriosis previously documented by laparoscopy.


RESULTS
All patients presented a sigmoid localization of endometriosis with different degree of stenosis and underwent sigmoid resection, followed by a resolution of abdominal symptoms.


CONCLUSIONS
Although the exact frequency of intestinal endometriosis is difficult to know because of the lack of specific symptoms and reliable investigations, it has been estimated that implants to the bowel may occur in 3%-37% of women affected by endometriosis. The sigmoid colon is the most common site of localization. The main symptoms are pelvic pain, dysmenorrhea, infertility and diarrhoea or constipation; rarely patients present bowel occlusion due to stenosis (less than 15% of the cases) or cyclic rectal bleeding.


CONCLUSIONS
Generally, intestinal endometriosis is not suspected preoperatively in those patients without a past history of this condition; however an accurate diagnosis can be provided throughout laparoscopy, before open surgery. The hormonal therapy is not successful in alleviating moderate to severe obstructive symptoms. Thus surgery still remains the most effective treatment for advanced intestinal endometriosis.
Caterino
S
S
Divisione di IV Patologia Chirurgica, Dipartimento di Chirurgia Pietro Valdoni, Università degli Studi di Roma La Sapienza.
Ricca
L
L
Cavallini
M
M
Ciardi
A
A
Camilli
A
A
Ziparo
V
V
D000328:Adult; D004715:Endometriosis / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D012810:Sigmoid Diseases / Q000601:surgery*