title: Symptomatic intestinal endometriosis requiring surgical resection: clinical presentation and preoperative diagnosis.
abstract: OBJECTIVE
  Intestinal endometriosis (IE) can present with varied symptoms, making the diagnosis difficult. Modalities have been described to evaluate IE, but few can provide a confirmatory diagnosis. A preoperative diagnosis of IE may help guide management. We sought to describe the presentation, diagnostic evaluation, histology and operative management of 89 patients with tissue-confirmed symptomatic IE.
  
  
  METHODS
  The records of 89 patients from a single institution with histologically confirmed, symptomatic IE from 1 January 1994 to 30 September 2009 were reviewed.
  
  
  RESULTS
  Abdominal pain was the most common symptom in patients with IE; however, rectal bleeding was significantly associated with IE of the distal colon (P=0.02), while dysfunctional uterine bleeding was seen more in patients with proximal IE (P=0.01). Preoperative confirmation of IE was uncommon; colonoscopy with biopsy confirmed the diagnosis in 29.6% of patients tested and only 15% of patients with IE had histologic lesions involving mucosa. In the five patients who underwent endoscopic ultrasound (EUS), the diagnosis of IE was established in all cases (n=4) where histology or cytology was obtained. Malignancy was considered nearly as frequently as IE preoperatively, and 90.4% of patients underwent laparotomy as the initial surgical approach.
  
  
  CONCLUSIONS
  IE can present with a variety of manifestations, which may provide clues to location of bowel affected. Patients with known pelvic endometriosis and rectal bleeding are more likely to have distal bowel affected; EUS with tissue sampling may play a role if routine endoscopy fails to reveal the diagnosis. Making a diagnosis of IE preoperatively may allow for less invasive surgical approaches and better patient outcomes.
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Lia C
authors.initials: LC
authors.lastname: Kaufman
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Smyrk
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Levy
authors.forename: Felicity T
authors.initials: FT
authors.lastname: Enders
authors.forename: Amy S
authors.initials: AS
authors.lastname: Oxentenko
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D044963:Biopsy, Fine-Needle; D003937:Diagnosis, Differential; D004715:Endometriosis / Q000150:complications / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis / Q000209:etiology / Q000473:pathology* / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional; D055815:Young Adult