Colonic endometriosis

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Abstract
Conclusion Endometriosis of the sigmoid flexure and rectosigmoidal area should be suspected in any woman who has symptoms of progressive colonic obstruction, pain on defecation, abdominal cramps and rectal bleeding associated with menstruation. Sigmoidoscopy should be performed in all these patients, but usually it will reveal no lesion. The only suggestive finding which might be found on sigmoidoscopy is a submucosal lesion covered by a puckered but intact mucosa. X-rays of the colon after barium enema may show a polypoid lesion but, more commonly, it will show a constricted area. Usually differentiation from carcinoma of the rectosigmoid is not possible by x-ray examination, but an intact mucosa in the narrowed area would favor a diagnosis of colonic endometriosis. Treatment should be determined according to the individual and should depend on the age of the patient and the severity of symptoms. Patients with minimal obstructive symptoms and moderate colonic involvement revealed by x-ray examination usually do not require a surgical operation. A patient in this category who is less than 40 years of age may show a remarkable response to suppressive hormonal therapy. Patients more than 40 years old may show dramatic relief of symptoms and regression of the colonic deformity after hysterectomy and oophorectomy. Surgical removal of the involved portion of the colon is indicated (1) in patients who have progressive or acute colonic obstruction associated with increasing pelvic discomfort, rectal bleeding and constipation associated with the menstrual cycle (2) to determine if the lesion is an adenocarcinoma of the rectosigmoid, and (3) when the x-ray examination shows a persistent constricted area in the rectosigmoid.

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