Endometriosis of the colon

Endometriosis of the large bowel: a report of 11 cases

The clinical and pathological features of 11 cases of large bowel endometriosis are reported, one of which also had lesions in the small intestine. All of the cases had rectal or rectosigmoid involvement. Altered bowel habit and pain were common symptoms but were rarely associated with the menstrual cycle. Sigmoidoscopy was generally unhelpful. Rectal or vaginal examination and barium enema often revealed a mass which was usually diagnosed preoperatively as a malignancy. A correct diagnosis was made preoperatively in only two cases; carcinoma was suspected in four and carcinoid in one case. Histological evidence of recent hemorrhage was confined to those cases where endometriosis seemed to be the major cause of intestinal symptoms. The colonic mucosa overlying the endometriotic deposits was commonly histologically abnormal. It showed a range of changes resembling colitis, solitary ulcer, prolapse or even neoplasm. An appreciation of these mucosal alterations is important to those reporting colonic and rectal biopsies; when observed to be focal in a female patient they should arouse a suspicion of endometriosis.

Diagnosis and management of endometriosis of the colon and rectum

Colon and rectal endometriosis is a relatively rare entity that may have a wide array of clinical symptomatology and radiographic findings. Thirty-two patients with a diagnosis of colon or rectal endometriosis were seen and treated at the Ferguson Clinic between 1960 and 1986. Diagnostic, pathologic, and therapeutic findings were reviewed. All patients, except one, had large-bowel symptoms. Ten patients had previous histories of pelvic endometriosis. When endometriosis of the colon causes significant symptoms or a neoplasm cannot be ruled out, partial colectomy is recommended. If pelvic endometriosis is extensive, removal of the endometriomas and reproductive organs should be entertained concurrent with bowel resection. Hormonal manipulation may be attempted in certain select patients, with very close follow-up.

Intestinal endometriosis

Endometriosis involving the intestine usually takes the form of asymptomatic, small, superficial serosal implants on segments of bowel lying in the pelvis in proximity to the genital organs. Deeper and more extensive intestinal wall involvement may result in obstruction and occasionally bleeding and requires distinction from a neoplasm or other inflammatory bowel process. Intestinal endometriosis should be considered in the differential diagnosis of recurring lower abdominal pain and other episodic bowel symptoms in women of child-bearing age. The diagnosis may be suspected based on the patient's history and frequently associated gynecologic symptoms. Due to the extramucosal location of the endometrioma, preoperative evaluation is unlikely to establish the diagnosis with certainty. Intestinal involvement by endometriosis, to the degree that it produces symptoms, almost always requires excision. Asymptomatic serosal lesions found incidentally at celiotomy for other disease should be biopsied and the diagnosis confirmed by frozen section. Symptomatic disease should be treated by resection of the involved intestine or by local excision, if the latter is feasible, and primary colon carcinoma can be excluded with confidence. Decisions regarding concurrent treatment for the underlying endometriosis should be made after consultation with an experienced gynecologist and must be based on the patient's menstrual status, age, and desire for future pregnancy.

Polypoid endometrioma of the rectosigmoid

Endometriosis of the bowel most often involves the sigmoid and rectosigmoid and appears as an intramural mass protruding into the lumen in a polypoid or constricting fashion. Occasionally there is an intraluminal mass without obvious intramural involvement. Endometriosis of bowel is rarely diagnosed at endoscopic biopsy. We present a patient with an intraluminal endometrioma with a positive endoscopic biopsy.

Endometriosis of the colon

A case of endometriosis of the colon is presented. The incidence, symptomatology and treatment are discussed.

Endometriosis of the sigmoid colon and rectum

Endometriosis is a common disease of women which occasionally causes serious symptoms in virtue of involvement of the distal large intestine. Two cases are reported, illustrating opposite ends of the spectrum of this disorder, one presenting with a complete large-bowel obstruction, and the other with periodical per-rectal bleeding. Endometriosis in these locations can closely mimic carcinoma, and from a consideration of our cases and the literature, those features which might help to distinguish one from the other are discussed. The treatment of endometriosis itself is briefly outlined. Either to avoid unnecessarily radical surgery, or to plan appropriate specific treatment at the time of surgery for the colorectal lesion, a preoperative diagnosis is desirable, but it is unlikely unless the clinician is aware of this unusual form of endometriosis.

Endometriosis of the bowel: role of bowel resection, superficial excision and oophorectomy in treatment

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