Diagnosis and managemnet of endometriosis of the colon and rectum

Publisher Website
Google Scholar
Abstract
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.A series of 32 cases of colon or rectal endometriosis, treated at Ferguson Clinic, Grand Rapids, Michigan, 1960-1986, aged 24-58 years, is presented, with comments on diagnosis and treatment. Endometriosis of the colon and rectum is rare, encompassing 3-34% of endometriosis cases, which occur in 4-17% of women generally. This series averaged 41 years old, 1.5 children, 10 were childless, 10 were postmenopausal when diagnosed. All had large bowel complaints as their main symptoms. 2 had colon obstructions, and 3 had rectal masses on examination. 9 had masses, 7 had strictures, and 10 had other findings on x-ray. Endoscopy revealed 8 extrinsic masses, 7 with edema, 2 with discoloration, 2 with spasm, and 1 with erythema and granularity. 4 of 11 treated with hormones improved: 1 with Danazol, 1 with Depo-provera, and 2 with birth control pills. 7 women treated with birth control pills did not respond. All but 2 women treated surgically improved and those who did not had reproductive organs removed only. This condition is often associated with menstrual rectal bleeding, and may persist after menopause. Colonoscopy is often difficult, and not definitive in diagnosis, except to rule out carcinoma. There are no reliable radiologic or endoscopic signs pathognomonic for endometriosis. Danazol should only be tried if birth control pills are ineffective. Partial colonic resection, in low risk patients, is recommended if the symptoms are disabling or extensive. Malignancy should be ruled out intraoperatively. To avoid colostomy, excisional biopsy should be attempted if the lesion is small.

This publication has 17 references indexed in Scilit: