title: Pathophysiological approach to bowel dysfunction after segmental colorectal resection for deep endometriosis infiltrating the rectum: a preliminary study.
abstract: BACKGROUND
  Colorectal segmental resection is performed worldwide in a majority of women presenting with symptomatic deep endometriosis infiltrating the rectum. The aim of the present study was to investigate the pathophysiological mechanisms involved in post-operative digestive dysfunction.
  
  
  METHODS
  We selected patients managed by colorectal resection for rectal endometriosis, who had developed post-operative severe constipation and whose follow up was superior to 24 months. To assess the mechanisms involved in the pathogenesis of this complaint, we performed a step-by-step work up including: low digestive tract endoscopy, colonic transit time measurement and when appropriate anorectal manometry, electromyography and defecographic evaluation.
  
  
  RESULTS
  Five out of 25 (20%) patients, whose age ranged from 27 to 41 years, were investigated for severe post-operative terminal constipation. Four different mechanisms responsible for terminal constipation were identified: tight stenosis of the colorectal anastomosis, post-operative neurological sequelae, colonic intussusception through the colorectal anastomosis and transit constipation that developed post surgery.
  
  
  CONCLUSIONS
  Post-operative constipation is a frequent complaint in women managed by colorectal resection for rectal endometriosis. A multidisciplinary approach is mandatory as pathophysiologic mechanisms may vary and prove difficult to understand. The risk of post-operative bowel dysfunction following colorectal endometriosis must be taken into account whenever this technique is proposed in young women presenting with a benign disease such as deep endometriosis.
authors.affiliation: Department of Gastroenterology, Rouen University Hospital, Rouen, France.
authors.forename: Laura
authors.initials: L
authors.lastname: Armengol-Debeir
authors.forename: Guillaume
authors.initials: G
authors.lastname: Savoye
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Leroi
authors.forename: Guillaume
authors.initials: G
authors.lastname: Gourcerol
authors.forename: Céline
authors.initials: C
authors.lastname: Savoye-Collet
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Tuech
authors.forename: Maud
authors.initials: M
authors.lastname: Vassilieff
authors.forename: Horace
authors.initials: H
authors.lastname: Roman
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D003108:Colonic Diseases / Q000601:surgery; D003248:Constipation / Q000209:etiology*; D003251:Constriction, Pathologic / Q000209:etiology; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D004715:Endometriosis / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010149:Postoperative Pain; D011183:Postoperative Complications; D012002:Rectal Diseases / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome