title: Mapping of bowel occult microscopic endometriosis implants surrounding deep endometriosis nodules infiltrating the bowel.
abstract: OBJECTIVE
  To provide a mapping of bowel occult microscopic endometriosis implants from colorectal specimens removed from patients who had undergone colorectal resection for deep endometriosis infiltrating the rectum.
  
  
  METHODS
  A series of consecutive patients with deep endometriosis infiltrating the rectum or/and sigmoid colon, between January 2013 and December 2013.
  
  
  METHODS
  University tertiary referral center.
  
  
  METHODS
  Twenty-six patients with deep endometriosis infiltrating the rectum or/and sigmoid colon.
  
  
  METHODS
  Surgical management by colorectal resection.
  
  
  METHODS
  Twenty-six patients with prospective recording of data (age, clinical history, symptoms, preoperative assessment, and intraoperative findings) underwent colorectal resection for bowel endometriosis. Mapping of occult microscopic endometriosis implants from specimens was established by histologic examination of 1,051 microsection slides taken from transversal macrosections of 3-mm thickness (40 microsections per patient on average).
  
  
  RESULTS
  The mean (SD) length of colorectal specimens was 110 (42) mm. Microimplants were found at varying distances up to 54 mm from macronodule limits. Multiple macroscopic nodules were identified in five patients (19.2%). In 18 specimens (69%) diffusion of endometriosis microimplants was longitudinal, whereas in 8 specimens (31%) diffusion was concentrated around the macroscopic nodule. Respectively, 31%, 19%, 8%, and 4% of patients presented with endometriosis microimplants at 2, 3, 4, and 5 cm from macroscopic nodules.
  
  
  CONCLUSIONS
  The present data suggest that in patients presenting with deep colorectal endometriosis, microscopically complete excision of rectal endometriosis may be unachievable because of bowel occult microscopic endometriosis implants located far from macroscopic nodules.
authors.affiliation: Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France; Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, Targu Mures, Romania.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Badescu
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: Research Group 4308 "Spermatogenesis and Gamete Quality", IHU Rouen Normandy, IFRMP23, Reproductive Biology Laboratory, Rouen University Hospital, Rouen, France.
authors.forename: Moutaz
authors.initials: M
authors.lastname: Aziz
authors.affiliation: Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, Targu Mures, Romania.
authors.forename: Lucian
authors.initials: L
authors.lastname: Puscasiu
authors.affiliation: Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, Targu Mures, Romania.
authors.forename: Claudiu
authors.initials: C
authors.lastname: Molnar
authors.affiliation: Department of Surgery, Rouen University Hospital, Rouen, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Huet
authors.affiliation: Department of Pathology, Rouen University Hospital, Rouen, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Sabourin
authors.affiliation: Department of Pathology, University of Medicine and Pharmacy, Targu Mures, Romania.
authors.forename: Simona
authors.initials: S
authors.lastname: Stolnicu
mesh_terms: D000328:Adult; D003082:Colectomy; D012809:Colon, Sigmoid / Q000473:pathology* / Q000601:surgery; D016208:Databases, Factual; D004715:Endometriosis / Q000473:pathology* / Q000601:surgery; D005260:Female; D005602:France; D006785:Hospitals, University; D006801:Humans; D012002:Rectal Diseases / Q000473:pathology* / Q000601:surgery; D012007:Rectum / Q000473:pathology* / Q000601:surgery; D012008:Recurrence; D012810:Sigmoid Diseases / Q000473:pathology* / Q000601:surgery; D062606:Tertiary Care Centers; D016896:Treatment Outcome
keywords: Bowel endometriosis; colorectal endometriosis; colorectal resection; deep endometriosis; histology