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World J Gastroenterol. Nov 14, 2014; 20(42): 15616-15623
Published online Nov 14, 2014. doi: 10.3748/wjg.v20.i42.15616
Bowel endometriosis: Colorectal surgeon’s perspective in a multidisciplinary surgical team
Albert M Wolthuis, Christel Meuleman, Carla Tomassetti, Thomas D’Hooghe, Anthony de Buck van Overstraeten, André D’Hoore
Albert M Wolthuis, Anthony de Buck van Overstraeten, André D’Hoore, Department of Abdominal Surgery, University Hospital Leuven, Leuven 3000, Belgium
Christel Meuleman, Carla Tomassetti, Thomas D’Hooghe, Leuven University Fertility Centre, Department of Obstetrics and Gynecology, University Hospital Leuven, Leuven 3000, Belgium
Author contributions: Wolthuis AM and Tomassetti C designed and performed research; Meuleman C, D’Hooghe T and D’Hoore A made substantial contributions to the concept and design of the study; Wolthuis AM, de Buck van Overstraeten A and Tomassetti C analyzed the data; Wolthuis AM, Meuleman C, Tomassetti C, D’Hooghe T, de Buck van Overstraeten A and D’Hoore A wrote the paper and approved the final version of the manuscript.
Correspondence to: Albert M Wolthuis, MD, Department of Abdominal Surgery, University Hospital Leuven, Herestraat 49, Leuven 3000, Belgium. albert.wolthuis@uzleuven.be
Telephone: +32-16-344265 Fax: +32-16-344832
Received: January 7, 2014
Revised: April 7, 2001
Accepted: June 26, 2014
Published online: November 14, 2014
Abstract

Endometriosis is a gynecological condition that presents as endometrial-like tissue outside the uterus and induces a chronic inflammatory reaction. Up to 15% of women in their reproductive period are affected by this condition. Deep endometriosis is defined as endometriosis located more than 5 mm beneath the peritoneal surface. This type of endometriosis is mostly found on the uterosacral ligaments, inside the rectovaginal septum or vagina, in the rectosigmoid area, ovarian fossa, pelvic peritoneum, ureters, and bladder, causing a distortion of the pelvic anatomy. The frequency of bowel endometriosis is unknown, but in cases of bowel infiltration, about 90% are localized on the sigmoid colon or the rectum. Colorectal involvement results in alterations of bowel habits such as constipation, diarrhea, tenesmus, dyschezia, and, rarely, rectal bleeding. Differential diagnosis must be made in case of irritable bowel syndrome, solitary rectal ulcer syndrome, and a rectal tumor. A precise diagnosis about the presence, location, and extent of endometriosis is necessary to plan surgical treatment. Multidisciplinary laparoscopic treatment has become the standard of care. Depending on the size of the lesion and site of involvement, full-thickness disc excision or bowel resection needs to be performed by an experienced colorectal surgeon. Long-term outcomes, following bowel resection for severe endometriosis, regarding pain and recurrence rate are good with a pregnancy rate of 50%.

Keywords: Endometriosis, Colorectal endometriosis, Deeply infiltrative endometriosis, Laparoscopy, Diagnosis, Treatment

Core tip: Multidisciplinary laparoscopic treatment of extensive endometriosis with bowel involvement has become the standard of care. Depending on the size of the bowel lesion and site of bowel involvement, full-thickness disc excision or bowel resection needs to be performed by an experienced colorectal surgeon. This narrative review discusses in depth the role of a colorectal surgeon in a multidisciplinary team treating bowel endometriosis. From clinical and diagnostic work-up to surgical treatment for different colorectal localizations of endometriosis, each issue is addressed. Furthermore, postoperative outcomes, regarding symptom control, recurrence, and fertility, are discussed.