Bowel endometriosis occurs when tissues similar to endometrial tissue grow on the intestine. Endometriosis on the bowel can be superficial or deep. Intestinal endometriosis is the most common form of extragenital endometriosis. Untreated, bowel endometriosis can cause intestinal obstruction.
What is bowel endometriosis?
As a frequent type of endometriosis, bowel endometriosis consists of endometriosis lesions either on the surface or deep inside the bowel wall. In case of superficial bowel endometriosis, lesions are found on the surface of the intestine. Deep bowel endometriosis, lesions infiltrate the bowel wall.
Endometriotic tissues can affect any part of the intestine, however in about 90% of cases, they are located in the sigmoid colon or rectum. Intestinal endometriosis can also affect the peritoneum of the posterior pelvic compartment pouch of Douglas, the area behind the rectum, and the appendix.
Bowel endometriosis symptoms
Bowel endometriosis can be symptomatic or asymptomatic and can cause different symptoms. The most common symptoms are pain during intercourse and bowel movements.
Other symptoms include pelvic pain associated with menstruation, rectal pain, pain during sitting, constipation, bloating, constant abdominal discomfort, diarrhoea, abdominal cramps, and difficulty emptying the bowels completely.
Bowel endometriosis surgery
Surgical treatment for intestinal endometriosis depends on the location of the disease, the size and depth of the lesion, the presence or absence of stricture, and the level of expertise of the surgeon. The goal of surgical management of intestinal endometriosis is to remove as many endometriotic lesions as possible while reducing short- and long-term complications.
There are there specific techniques for intestinal endometriosis:
- rectal shaving
- disc resection
- segmental resection
Rectal shaving is used in case of superficial rectal lesions, when the lesions do not infiltrate the muscular layer of the anterior rectal wall or infiltrate it on a very small surface.
Disc resection consists of removal of the affected area, followed by suture of the defect. It can be done in many ways, depending on the experience and preference of the surgeon. These are: with the help of a circular stapler or by shaving followed by transanal resection using the Rouen technique.
Segmental resection involves the complete removal of the diseased portion of the intestine. Afterwards an end-to-side or end-to-end digestive anastomosis of the two intestinal segments is done.
