| Theme |
Current Topics on Anorectal Disorders |
| Title |
Intestinal Endometriosis |
| Author |
Kazufumi Yamagata |
First Department of Internal Medicine, Hirosaki University School of Medicine |
| Author |
Yoh Ishiguro |
First Department of Internal Medicine, Hirosaki University School of Medicine |
| Author |
Satoko Ebina |
First Department of Internal Medicine, Hirosaki University School of Medicine |
| Author |
Koji Shimaya |
First Department of Internal Medicine, Hirosaki University School of Medicine |
| Author |
Hiroto Hiraga |
First Department of Internal Medicine, Hirosaki University School of Medicine |
| Author |
Akihiro Munakata |
First Department of Internal Medicine, Hirosaki University School of Medicine |
| [ Summary ] |
The gastrointestinal tract is the most common site of extrapelvic endometriosis, with the sigmoid colon, descending colon, and rectum representing the areas most commonly involved. Rectovaginal septum with rectosigmoid involvement is thought to be the most common form of extrapelvic endometriosis. These lesions may be present with intestinal obstructions or symptoms such as pain, distension, diarrhea, constipation, or rectal bleeding. They also may be incidental findings at the time of laparoscopy.
Endometriosis can be determined from the history, pelvic examination, and ancillary tests. Endometriosis is classically defined as the presence of endometrial tissue (specifically, endometrial glands and stroma) outside the uterine cavity. It is still argued that diagnosis can be made visually and does not need pathologic confirmation. It is suggested that characteristic signs and symptoms are helpful in diagnosing in gastrointestinal endometriosis. When rectovaginal or uterosacral ligament involvement is noted, the pain is often referred to the rectum or lower back. Pain radiating down the leg may also be seen. The pain may progress and begin prior to the onset of menses or become chronic and be noted throughout most of the menstrual cycle in conjunction with the rectal bleeding. Colonoscopy and double-contrast barium examination is useful to define gastrointestinal involvement. Treatment is dependent on symptoms, extent of disease, location, and degree of bowel dysfunction. Neoplastic changes in endometriosis of the bowel are very rare. |