title: Colorectal Endometriosis Responsible for Bowel Occlusion or Subocclusion in Women With Pregnancy Intention: Is the Policy of Primary in Vitro Fertilization Always Safe?
abstract: OBJECTIVE
  To discuss the risk of bowel occlusion or subocclusion in patients with pregnancy wish and deep colorectal endometriosis, when surgery is postponed until after conception.
  
  
  METHODS
  A prospective series of consecutive patients managed for occlusion or subocclusion between January 2012 and January 2015 (Canadian Task Force classification II-2). Deep endometriosis had previously been diagnosed in all patients; however, they were advised to postpone surgery until after conception.
  
  
  METHODS
  University tertiary referral center.
  
  
  METHODS
  Twelve women with bowel occlusion or subocclusion due to deep endometriosis and desiring pregnancy.
  
  
  METHODS
  Surgical management including colorectal resection.
  
  
  METHODS
  Digestive symptoms, including standardized gastrointestinal questionnaires and preoperative imaging assessment of deep endometriosis.
  
  
  RESULTS
  The patients enrolled in the series represent 5% of 241 patients with colorectal endometriosis managed over 37 consecutive months. Major digestive complaints were bloating, defecation pain, constipation, liquid stools, and a feeling of incomplete stool evacuation. The median length of digestive tract stenosis was 50 mm (range, 20-100 mm). In 8 patients (67%), computed tomography-based virtual colonoscopy revealed a virtual digestive lumen. The median length of colorectal specimen removed was 120 mm (range, 60-200 mm). Three patients (25%) had Clavien-Dindo IIIb and IVa postoperative complications with favorable outcomes within up to 20 days after surgery.
  
  
  CONCLUSIONS
  Given the risk of bowel occlusion or subocclusion in young patients with colorectal endometriosis, an exhaustive assessment of deep disease and advice at a tertiary referral center appears to be mandatory before prioritizing primary in vitro fertilization instead of primary surgery.
authors.affiliation: Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France; Research Group 4308, Spermatogenesis and Gamete Quality, IHU Rouen Normandy, IFRMP23, Reproductive Biology Laboratory, Rouen University Hospital, Rouen, France. Electronic address: horace.roman@gmail.com.
authors.forename: Horace
authors.initials: H
authors.lastname: Roman
authors.affiliation: Department of Gynecology and Obstetrics, Targu Mures University, Targu Mures, Romania.
authors.forename: Lucian
authors.initials: L
authors.lastname: Puscasiu
authors.affiliation: Department of Radiology, Rouen University Hospital, Rouen, France.
authors.forename: Marta
authors.initials: M
authors.lastname: Lempicki
authors.affiliation: Department of Surgery, Rouen University Hospital, Rouen, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Huet
authors.affiliation: Department of Surgery, Rouen University Hospital, Rouen, France.
authors.forename: Rachid
authors.initials: R
authors.lastname: Chati
authors.affiliation: Department of Surgery, Rouen University Hospital, Rouen, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Bridoux
authors.affiliation: Department of Surgery, Rouen University Hospital, Rouen, France.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Tuech
authors.affiliation: Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Abo
mesh_terms: D000328:Adult; D003108:Colonic Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004715:Endometriosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D006801:Humans; D033182:Intention; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis*; D016742:Preconception Care / Q000379:methods*; D011247:Pregnancy; D011446:Prospective Studies; D011859:Radiography; D012002:Rectal Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D018570:Risk Assessment; D016896:Treatment Outcome
keywords: Colorectal resection; Endometriosis; Occlusion; Stenosis; Subocclusion