title: Surgical outcome and long-term follow-up after segmental colorectal resection in women with a complete obstruction of the rectosigmoid due to endometriosis.
abstract: BACKGROUND
  Intestinal involvement is reported in up to 12% of women with endometriosis. Complete large bowel obstruction is a rare complication of intestinal endometriosis. It is estimated to occur in less than 1% of the cases.
  
  
  OBJECTIVE
  The aim of this study is to evaluate the surgical outcome and long-term follow-up after segmental colorectal resection in women with a complete obstruction of the rectosigmoid due to endometriosis. In addition, the diagnostic work-up is described and discussed in view of the current literature.
  
  
  METHODS
  We present a case series of 5 patients with a complete obstruction of the rectosigmoid due to endometriosis who were finally treated in our hospital within a multidisciplinary endometriosis team. We retrospectively analyzed all patients with this condition who were referred in the period January 2000 to December 2006.
  
  
  RESULTS
  All patients (mean age 31.8 years, range 25-43 years) underwent emergency surgery resulting in a diverting colostomy before referral to our hospital. The principal diagnostic tool used was magnetic resonance imaging which demonstrated in all patients multiorgan endometriosis with complete obstruction of the rectosigmoid. Thereafter, all patients underwent a segmental colorectal resection by re-laparotomy. The diagnosis intestinal endometriosis was histologically confirmed in all cases. After surgery no major complications occurred. During a follow-up of 18-36 months, residual symptoms such as chronic constipation, deep dyspareunia and chronic pelvic pain were reported in 2 patients. No recurrences of intestinal endometriosis occurred.
  
  
  CONCLUSIONS
  In our case series, segmental colorectal resection showed a favorable surgical outcome with no major complications. In the long-term follow-up, a limited number of residual symptoms were reported and no recurrences occurred. Intestinal endometriosis as a cause of bowel obstruction is often a diagnostic challenge mimicking a broad spectrum of diseases. It should be included in the differential diagnosis in women of reproductive age presenting with any symptoms of bowel obstruction. Magnetic resonance imaging is recommended as the primary imaging technique in such cases. In our opinion, these patients should be treated in a multidisciplinary setting.
authors.affiliation: Department of Gastrointestinal Surgery, Endometriosis Center VUMC, VU University Medical Center, de Boelelaan 1117, Amsterdam, The Netherlands.
authors.forename: M J H
authors.initials: MJ
authors.lastname: de Jong
authors.forename: V
authors.initials: V
authors.lastname: Mijatovic
authors.forename: J H T M
authors.initials: JH
authors.lastname: van Waesberghe
authors.forename: M A
authors.initials: MA
authors.lastname: Cuesta
authors.forename: P G A
authors.initials: PG
authors.lastname: Hompes
mesh_terms: D000328:Adult; D004715:Endometriosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D012002:Rectal Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D012810:Sigmoid Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome