ABSTRACT
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.
Subject(s)
Digestive System Surgical Procedures/methods , Endometriosis/surgery , Intestinal Diseases/surgery , Anal Canal/surgery , Conservative Treatment , Contraceptives, Oral, Combined/therapeutic use , Danazol/therapeutic use , Endometriosis/diagnostic imaging , Endometriosis/drug therapy , Endosonography , Estrogen Antagonists/therapeutic use , Female , Humans , Intestinal Diseases/diagnostic imaging , Intestinal Diseases/drug therapy , Laparoscopy , Leuprolide/therapeutic use , Magnetic Resonance Imaging , Ovulation Inhibition , Pelvic Pain , Postoperative Complications/prevention & control , Progestins/therapeutic use , Rectal Diseases/diagnostic imaging , Rectal Diseases/drug therapy , Rectal Diseases/surgery , UltrasonographyABSTRACT
Endometriosis is commonly misdiagnosed, even among many experienced gynecologists. Gastrointestinal and genitourinary endometriosis is particularly difficult to diagnose, and is commonly mistaken for other pathologies, such as irritable bowel syndrome, interstitial cystitis, and even psychological disturbances. This leads to delays in diagnosis, mismanagement, and unnecessary testing. In this review, we will discuss the diagnosis and management of genitourinary and gastrointestinal endometriosis. Medical management may be tried first, but often fails in cases of urinary tract endometriosis. This is particularly important in cases of ureteral endometriosis because silent obstruction can lead to eventual kidney failure. Thus, we recommend complete surgical treatment in these cases. Bladder endometriosis may be managed more conservatively, and only if symptomatic, because these rarely lead to significant morbidity. In cases of bowel endometriosis, we recommend medical management first in all cases, and the least invasive surgical management only if medical treatment fails. This is due to the extensive nervous and vasculature supply to the lower rectum. Injury to these nerves and vessels can cause significant complications and postoperative morbidity.
