Surgery of endometrioma of the ileum and colon

Abstract

1. 1. The subject of endometrioma of the small and large intestine associated with intestinal obstruction is reviewed. 2. 2. The clinical manifestations, the treatment and the associated pathology are presented pertinent to ten patients with involvement of the intestine by isolated endometrioma. Range in age of these ten patients was thirty-three to forty-eight years. 3. 3. A solitary endometrioma of long-standing may involve the ileum and sigmoid or rectosigmoid colon to such an extent that gastrointestinal symptoms and signs of partial or complete intestinal obstruction may appear. 4. 4. The occurrence of obstructive symptoms, accentuated preceding or during the menstrual period, should suggest endometrioma of the small or large intestine in the differential diagnosis of intestinal obstruction. 5. 5. An endometrioma of the small or large intestine may be diagnosed on an awareness of the possibility of the disease, a complete history, and a combined rectovaginal examination coupled with the findings of the proctoscopic and barium enema examinations. 6. 6. The symptomatology and the gross appearance of an endometrioma and carcinoma of the colon are so similar that it is often difficult to distinguish these lesions even at operation. Anterior resection of the colon is recommended if any doubt exists. 7. 7. The management of patients with a solitary endometrioma or multiple endometrial implants affecting the small or large intestine should be individualized. The choice of treatment depends upon the age of the patient, the evaluation of the severity of symptoms, and the extent of the involvement of the intestine and pelvic organs. 8. 8. The recommended treatment of an acute obstruction of the ileum and sigmoid or rectosigmoid colon by an endometrioma is resection with end to end anastomosis, whenever possible. A Mikulicz procedure or lateral anastomosis may be indicated in patients who are poor risks. 9. 9. When chronic or recurring symptoms of low-grade intestinal obstruction are present, segmental resection of the colon may be contemplated. Local excisions of small isolated endometriomas may be adequate treatment in certain instances. 10. 10. In the surgical management of these patients, the preservation of ovarian function is advocated whenever possible.