Anatomical and Surgical Considerations for Ileocolic Endometriosis

Abstract

<h3>Study Objective</h3> We aim to review the incidence, location, and management of bowel endometriosis, as well as demonstrate anatomical considerations for surgical resection of ileocolic lesions. <h3>Design</h3> This video briefly reviews the background of bowel endometriosis and indications for surgical excision. We present a case of a patient diagnosed with a symptomatic ileocolic endometriosis lesion and review the preoperative imaging. We demonstrate the steps of a medial-to-lateral surgical approach for ileocolic resection and highlight the relevant surgical anatomy. <h3>Setting</h3> This procedure was performed at a large academic institution with a multidisciplinary team of minimally invasive gynecologists and colorectal surgeons. <h3>Patients or Participants</h3> The case presented is a 44-year-old female with a known history of stage IV endometriosis. She presented with acute abdominal pain, nausea and vomiting associated with her menses, and was found to have a small bowel obstruction from a 3cm lesion thought to be an endometrioma. She failed conservative management and was thoroughly counseled about the need for surgical intervention. Pelvic MRI was performed for preoperative planning. <h3>Interventions</h3> Laparoscopic ileocolic resection is performed utilizing a medial-to-lateral approach for excision of a symptomatic 3cm ileocecal endometrioma. <h3>Measurements and Main Results</h3> Successful excision of the endometrioma with a side-to-side ileocolic anastomosis was performed with resolution of the patient's symptoms. <h3>Conclusion</h3> The bowel is the most common extragenital site for endometriosis to occur, with the highest rate of lesions located in the rectosigmoid colon. Lesions can be either superficial or deeply infiltrative and can lead to a range of symptoms. A serious sequela of bowel endometriosis includes bowel obstruction requiring surgical intervention. We present a case of a 44-year-old female with acute bowel obstruction from a 3cm ileocecal endometrioma and demonstrate a medial-to-lateral surgical technique for ileocolic resection while emphasizing the relevant anatomical structures.