Laparoscopic management of ileal endometriosis: presented as sub-acute intestinal obstruction (original) (raw)
Related papers
Laparoscopic treatment of recurrent small bowel obstruction secondary to ileal endometriosis
Journal of Minimally Invasive Gynecology, 2007
Endometriosis is a relatively common condition characterized by implantation and proliferation of endometrial glands outside the uterus affecting 8% to 15% of women. Intestinal involvement is common, reported in 12% to 37% of individuals with the disease. The sites most often affected are the sigmoid colon and rectum (85%), while small bowel involvement is seen less frequently (7%) and usually confined to the distal ileum. The cecum (3.6%) and appendix (3%) are the sites least affected.
Bowel endometriosis: a surgical red flag
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Endometriosis is a disease restricted usually to the female genital tract. Involvement of the bowel by this disease can lead to a diagnostic dilemma due to the great variation in the symptomatology. Awareness of the pathophysiology, clinical features and diagnostic modalities is of utmost importance to decide the modality of treatment. Hormonal manipulation and surgical resection are the two modalities of treatment. The choice depends upon critical analysis of clinical and radiological findings and the desire to have pregnancy in cases associated with infertility.
Journal of Minimally Invasive Gynecology, 2009
Study objective: To assess the feasibility and safety of laparoscopic bowel resections for endometriosis performed by gynecologic surgeons. Design: Retrospective cohort study (Canadian Task Force Classification II-3). Setting: Fertility and pelvic surgery clinics. Patients: One hundred sixty-eight women (age 21-53 years) with symptoms including pelvic pain, infertility, or both with 252 bowel endometriotic lesions underwent laparoscopic bowel resection performed by gynecologic surgeons between May 2000 and January 2008. Interventions: Laparoscopic procedures for excision of several endometriotic nodes and lesions included shaving resection (LscShR), discoid resection (LscDR), segmental resection (LscSgR), terminal ileal resection (LscIR), partial cecal resection (LscCR), and appendectomy (LscAp). Measurements and Main Results: The 168 patients underwent 172 laparoscopic bowel resections (4 patients were operated on twice) by the same surgeon. Lesions were distributed as follows: 133 (79%) in the rectum, 61 (24%) in the sigmoid colon, 47 (19%) in the appendix, 5 (2%) in the terminal ileum, 3 (1%) in the descending colon, and 3 (1%) in the cecum. At surgeon discretion, 12 lesions were not resected. A total of 216 bowel procedures were necessary to remove the 240 lesions include shaving resection in 22 patients (10%), discoid resection in 52 (24%), segmental resection in 92 (42%), terminal ileal resection in 2 (1%), partial cecal resection in 1 (0.6), and appendectomy in 47 (22%). Major complications occurred in 13 patients (7.6%) and included rectovaginal fistula in 3 patients (1.7%), rectosigmoid anastomosis dehiscence and bowel occlusion in 1 patient each (0.6%), and persistent bowel dysfunction in 4 patients (2.3%). These results are comparable to those reported in the literature to date. Complete relief of symptoms (measured using the Visick scale) was noted in patients with dysmenorrhea (59%), dyspareunia (75%), noncyclic pelvic pain (90%), pain on defecation (100%), constipation (83%), and cyclic rectal bleeding (100%). Conclusion: Surgery to treat bowel endometriosis can be safely and efficiently performed by the gynecologic pelvic surgeon. Meticulous training and a multidisciplinary approach to comprehensive operative care are necessary. These findings can be validated by prospective collaborative studies and reports from other surgeons.
Surgery for gastrointestinal endometriosis: indications and results
Acta chirurgica Belgica
Although gastrointestinal endometriosis is an uncommon and often unexpected finding, the best treatment requires removal of all endometriotic lesions. The purpose of our study was to report our experience with the diagnosis and treatment of bowel endometriosis. From January 1997 to January 2004, 13 patients (mean 35.7y ; range 21-55y) were operated for bowel endometriosis. We noted: age, history of endometriosis, previous pregnancies, preoperative investigations and symptoms, operative procedure and intraoperative findings. Follow-up varied between one month postoperative examination and seven years. Presenting symptoms of the cases were: acute appendicitis (3), dysmenorrhoea (7), constipation (6), pelvic pain (2), rectal bleeding (3) and dyspareunia (2). Operative management was performed in accordance with the anatomical distribution. Seven patients had a history of previous operations and multifocal involvement was present in 61.5% of cases. At a median follow-up of 12.2 months, ...
Laparoscopic Management of Intestinal Endometriosis
The Journal of the American Association of Gynecologic Laparoscopists, 2000
Intestinal involvement by endometriosis traditionally required open laparotomy for bowel resection and anastomosis. Operative laparoscopy may offer the most effective form of treatment for these women. Two women with endometriosis of the rectum and right hemicolon, respectively, underwent transvaginal resection of the rectum and laparotomy for hemicolectomy, assisted by laparoscopy. The only morbidity was postoperative ileus in the former patient. Both women were asymptomatic at the 6-week postoperative visit.
Bowel endometriosis: diagnosis and management
American journal of obstetrics and gynecology, 2017
The most common location of extragenital endometriosis is the bowel. Medical treatment may not provide long-term improvement in patients who are symptomatic, and consequently most of these patients may require surgical intervention. Over the past century, surgeons have continued to debate the optimal surgical approach to treating bowel endometriosis, weighing the risks against the benefits. In this expert review we will describe how the recommended surgical approach depends largely on the location of disease, in addition to size and depth of the lesion. For lesions approximately 5-8 cm from the anal verge, we encourage conservative surgical management over resection to decrease the risk of short- and long-term complications.
Bowel endometriosis: Recent insights and unsolved problems
World Journal of Gastrointestinal Surgery, 2011
Bowel endometriosis affects between 3.8% and 37% of women with endometriosis. The evaluation of symptoms and clinical examination are inadequate for an accurate diagnosis of intestinal endometriosis. Transvaginal ultrasonography is the first line investigation in patients with suspected bowel endometriosis and allows accurate determination of the presence of the disease. Radiological techniques (such as magnetic resonance imaging and multidetector computerized tomography enteroclysis) are useful for estimating the extent of bowel endometriosis. Hormonal therapies (progestins, gonadotropin releasing hormone analogues and aromatase inhibitors) significantly improve pain and intestinal symptoms in patients with bowel stenosis less than 60% and who do not wish to conceive. However, hormonal therapies may not prevent the progression of bowel endometriosis and, therefore, patients receiving long-term treatment should be periodically monitored. Surgical excision of bowel endometriosis should be offered to symptomatic patients with bowel stenosis greater than 60%. Intestinal endometriotic nodules may be excised by nodulectomy or segmental resection. Both surgical procedures improve pain, intestinal symptoms and fertility. Nodulectomy may be associated with a lower rate of complications.
Laparoscopic ileocecal resection for bowel endometriosis
Surgical Endoscopy and Other Interventional Techniques, 2011
Background Ileocecal endometriosis is a very rare entity, and its diagnosis is usually made during surgery for other endometriosis sites or, rarely, because of direct complications of ileal involvement. This study was designed to analyze perioperative and long-term outcomes after bowel resection for ileocecal endometriosis. Methods All patients who underwent surgery for ileocecal endometriosis between October 2004 and January 2008 were prospectively collected and analyzed. Results Thirty-one women (median age, 34 (range, 25–40) years) were identified. Ileocecal endometriosis was diagnosed during surgery in all patients, and it was associated with colorectal endometriosis in 29 patients (94%). All patients underwent laparoscopic ileocecal resection with no laparotomic conversion. Rectosigmoid or rectal resections was associated in 28 patients (90%) and nodulectomy for sigmoid endometriosis in 1 patient. Median duration of surgery was 301 (range, 90–480) min. Other associated surgical procedures included total hysterectomy (n = 3, 14%), ureterolysis (n = 7, 23%), excision of vesical (n = 4, 13%), vaginal (n = 8, 26%), and parametrial (n = 3, 14%) nodules. There was no mortality. Four patients (13%) required blood transfusions and one a reoperation for bleeding. In a patient who performed ureterolysis, a ureteral fistula occurred. The median hospital stay was 7 (range, 5–18) days. Long-term (>12 months) follow-up data were available for 18 patients. After a median follow-up of 27 months, in 12 of 18 patients (67%) defecation after surgery was normal. Only one patient developed recurrence, which is under medical treatment. Conclusions Laparoscopic ileocecal resection is safe and feasible and should be considered as part of surgery for endometriosis with radical intent.
Use of strictureplasty technique for surgical treatment of ileal endometriosis: a case series
F1000Research, 2020
Intestinal deep infiltrating endometriosis is the most frequent extragenital localisation and its traditional surgical treatment is segmental resection of the affected tract. The need for implementing alternative techniques in the treatment of intestinal endometriosis arises from those cases of multiple ileal and recto-sigmoidal localisations, in which removing excessive lengths of intestine could lead to a higher rate of adverse events. Ileal endometriosis represents 4.7% of all intestinal localisations, often associated with multiple lesions and yet, to the best of our knowledge, there are no data on techniques other than intestinal resection for its treatment. Since its capacity to solve fibrostenotic lesions without removing centimeters of intestine, strictureplasty is widely implemented in the management of Crohn’s disease. We propose the use of strictureplasty for the treatment of ileal endometriosis. We performed surgical treatment for symptomatic deep infiltrating endometrio...