Surgical management of endometrioma of the colon

Abstract

A review is presented of the clinical history and findings in 10 patients, 33 to 48 years of age, subjected to surgery for removal of an endometrioma of the colon. An accompanying endometrial lesion of the ileum was resected in 1 case.Certain observations are recorded as a result of this study. An endometrioma of the colon may be diagnosed on an awareness of the disease and a careful clinical history. A previous laparotomy without relief of symptoms is significant. Inquiry should include questions regarding dysmenorrhea, infertility, and dyspareunia. Symptoms of endometriosis of the colon are often exaggerated preceding and during menstruation. Bleeding from the colon is not a constant and frequent symptom. The signs of an acute or partial intestinal obstruction may be present. Seven of 10 patients in this series presented symptoms suggestive of partial intestinal obstruction. Inasmuch as the symptomatology as well as the gross appearance of endometrioma and carcinoma are quite similar, recognition of the actual pathology in the colon may be difficult, even at operation. A combined rectovaginal examination will diagnose low-lying lesions of the colon. Proctoscopy and barium enema examinations are essential studies in the preoperative work-up.The management of each case varies and depends upon the age of the patient, the severity of the symptoms, and the extent of the endometrial involvement of the intestine and pelvic organs. An acute obstruction of the sigmoid colon must be relieved by a preliminary transverse colon colostomy followed by an elective segmental resection of the colon. Anterior resection with primary end-to-end anastomosis is recommended for relief of symptoms due to partial intestinal obstruction. Local excision of small isolated endometriomas of the rectosigmoid colon may be adequate treatment. In patients 40 to 45 years of age, total hysterectomy with bilateral oophorectomy should result in regression of endometrial lesions of the colon; however, the possibility of carcinoma of the colon must not be overlooked in these instances.