Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 26, 2019; 7(4): 441-451
Published online Feb 26, 2019. doi: 10.12998/wjcc.v7.i4.441
Intestinal endometriosis: Diagnostic ambiguities and surgical outcomes
Jun Woo Bong, Chang Sik Yu, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Jin Cheon Kim
Jun Woo Bong, Chang Sik Yu, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Jin Cheon Kim, Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul 05505, South Korea
Author contributions: Bong JW contributed to the manuscript writing, performing data collecting and analysis; Yu CS contributed to the drafting conception and design; Lee JL, Kim CW and Yoon YS contributed to the collecting data; Park IJ, Lim SB and Kim JC contributed to the confirmation results.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of Asan Medical Center.
Informed consent statement: This study is retrospective study and informed consent is waived because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment.
Conflict-of-interest statement: There is no conflict of interest or no source of support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Chang Sik Yu, MD, PhD, Professor, Surgeon, Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea. csyu@amc.seoul.kr
Telephone: +82-2-30103494 Fax: +82-2-30106701
Received: November 5, 2018
Peer-review started: November 5, 2018
First decision: December 20, 2018
Revised: January 9, 2019
Accepted: January 26, 2019
Article in press: January 26, 2019
Published online: February 26, 2019
Processing time: 114 Days and 2.7 Hours
Abstract
BACKGROUND

Endometriosis is a common disease for women of reproductive age. However, when it involves intestines, it is difficult to diagnose preoperatively because its symptoms overlap with other diseases and the results of evaluations can be unspecific. Thus it is important to know the clinical characteristics of intestinal endometriosis and how to exactly diagnose.

AIM

To analyze patients in whom intestinal endometriosis was diagnosed after surgical treatments, and to evaluate the clinical characteristics of preoperatively misdiagnosed cases.

METHODS

We retrospectively reviewed the pathologic reports of 30 patients diagnosed as having intestinal endometriosis based on surgical specimens between January 2000 and December 2017. We reviewed their clinical characteristics and surgical outcomes.

RESULTS

Twenty-three (76.6%) patients showed symptoms associated with endometriosis, with dysmenorrhea being the most common (n = 9, 30.0%). Thirteen patients (43.3%) had a history of pelvic surgeries. Ten patients (33.3%) had a history of treatment for endometriosis. Only 4 patients (13.3%) had a diagnosis of endometriosis based on endoscopic biopsy findings. According to preoperative evaluations, 13 patients (43.3%) had an initial diagnosis of pelvic endometriosis and 17 patients (56.6%) were misdiagnosed as having other diseases. The most common misdiagnosis was submucosal tumor in the large intestine (n = 8, 26.7%), followed by malignancies of the colon/rectum (n = 3, 10.0%) and ovary (n = 3, 10.0%). According to the Clavien-Dindo classification, 5 complications were grade I or II and 2 complications were grade IIIa. The median follow-up period was 26.9 (0.6-132.1) mo, and only 1 patient had a recurrence of endometriosis.

CONCLUSION

Intestinal endometriosis is difficult to diagnose preoperatively because it mimics various intestinal diseases. Thus, if women of reproductive age have ambiguous symptoms and signs with nonspecific radiologic and/or endoscopic findings, intestinal endometriosis should be included in the differential diagnosis.

Keywords: Endometriosis; Intestinal endometriosis; Diagnosis; Surgery; Treatment

Core tip: Intestinal endometriosis is difficult to diagnose preoperatively because it mimics various intestinal diseases. The aim of this study is to analyze patients in whom intestinal endometriosis was diagnosed after surgical treatments, and to evaluate the clinical characteristics of preoperatively misdiagnosed cases. According to preoperative evaluations, 13 patients (43.3%) had an initial diagnosis of pelvic endometriosis and 17 patients (56.6%) were misdiagnosed as having other diseases. Only 4 patients (13.3%) had a diagnosis of endometriosis based on endoscopic biopsy findings. Thirteen patients (43.3%) had a history of pelvic surgeries. Ten patients (33.3%) had a history of treatment for endometriosis. Thus, if women of reproductive age have ambiguous symptoms and signs with nonspecific radiologic and/or endoscopic findings, intestinal endometriosis should be included in the differential diagnosis.