ENDOMETRIOSIS OF THE SMALL AND LARGE INTESTINE

Abstract

Summary A group of 12 cases of pelvic endometriosis involving the small intestine and bowel are presented. As pelvic endometriosis is most common between 25 and 40 years of age and is usually associated with infertility, it is of interest that the average age in this group was 40 years—the youngest patient being 23 years old and the oldest 52 years; also, that of the 9 married women, 6 had children. It is probable that many young women have unrecognized pelvic endometriosis that is a cause of various so-called functional or reflex disorders of the intestinal tract. The disease often escapes recognition and a positive diagnosis is infrequently made before operation. It may simulate appendicitis and terminal ileitis in its acute manifestation, and chronic diverticulitis and cancer of the rectosigmoid in its more chronic form, especially in older individuals. It commonly invades the serosal surfaces and the deeper layers of the bowel, the mucosa invariably escaping. Endometriosis may be more often suspected as a cause of obscure functional and organic lesions in the intestinal tract if it is kept in mind that the symptoms and physical signs frequently are associated with dysmenorrhea and menstrual disturbances and that pelvic examination will in most cases reveal evidence of the disease in the pelvis. The treatment of endometriosis, which has been well summarized by Payne,l' consists of routine observation, surgical intervention or irradiation depending upon the severity of symptoms, patient's age, and the removability of the major lesions. In the absence of complications conservative treatment is desirable, particularly in women of the child-bearing age with the preservation of ovarian and, if possible, menstrual and procreative functions. In recent years androgen therapy 18 has appeared to be efficacious in some cases. One of the cases reported (case 12) illustrates, as far as we can determine, what may well be a syndrome hitherto unrecognized in the literature of disordered motor function of the small intestine due to peritoneal imitation, the latter being the result of free endometrial fluid in the peritoneal cavity arising from pelvic endometriosis.