Bowel endometriosis: colorectal surgeon's perspective in a multidisciplinary surgical team.
Endometriosis is a gynecological condition that presents as endometrial-like tissue outside the uterus and induces a chronic inflammatory reaction. Up to 15% of women in their reproductive period are affected by this condition. Deep endometriosis is defined as endometriosis located more than 5 mm beneath the peritoneal surface. This type of endometriosis is mostly found on the uterosacral ligaments, inside the rectovaginal septum or vagina, in the rectosigmoid area, ovarian fossa, pelvic peritoneum, ureters, and bladder, causing a distortion of the pelvic anatomy. The frequency of bowel endometriosis is unknown, but in cases of bowel infiltration, about 90% are localized on the sigmoid colon or the rectum. Colorectal involvement results in alterations of bowel habits such as constipation, diarrhea, tenesmus, dyschezia, and, rarely, rectal bleeding. Differential diagnosis must be made in case of irritable bowel syndrome, solitary rectal ulcer syndrome, and a rectal tumor. A precise diagnosis about the presence, location, and extent of endometriosis is necessary to plan surgical treatment. Multidisciplinary laparoscopic treatment has become the standard of care. Depending on the size of the lesion and site of involvement, full-thickness disc excision or bowel resection needs to be performed by an experienced colorectal surgeon. Long-term outcomes, following bowel resection for severe endometriosis, regarding pain and recurrence rate are good with a pregnancy rate of 50%.
Albert M Wolthuis, Anthony de Buck van Overstraeten, André D'Hoore, Department of Abdominal Surgery, University Hospital Leuven, Leuven 3000, Belgium.
Albert M
AM
Wolthuis
Albert M Wolthuis, Anthony de Buck van Overstraeten, André D'Hoore, Department of Abdominal Surgery, University Hospital Leuven, Leuven 3000, Belgium.
Christel
C
Meuleman
Albert M Wolthuis, Anthony de Buck van Overstraeten, André D'Hoore, Department of Abdominal Surgery, University Hospital Leuven, Leuven 3000, Belgium.
Carla
C
Tomassetti
Albert M Wolthuis, Anthony de Buck van Overstraeten, André D'Hoore, Department of Abdominal Surgery, University Hospital Leuven, Leuven 3000, Belgium.
Thomas
T
D'Hooghe
Albert M Wolthuis, Anthony de Buck van Overstraeten, André D'Hoore, Department of Abdominal Surgery, University Hospital Leuven, Leuven 3000, Belgium.
Anthony
A
de Buck van Overstraeten
Albert M Wolthuis, Anthony de Buck van Overstraeten, André D'Hoore, Department of Abdominal Surgery, University Hospital Leuven, Leuven 3000, Belgium.
André
A
D'Hoore
D003299:Cooperative Behavior; D003952:Diagnostic Imaging; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D004715:Endometriosis / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D007410:Intestinal Diseases / Q000175:diagnosis / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D010348:Patient Care Team; D011237:Predictive Value of Tests; D016896:Treatment Outcome
Colorectal endometriosis; Deeply infiltrative endometriosis; Diagnosis; Endometriosis; Laparoscopy; Treatment