The surgical management of bowel endometriosis is provided in partnership with IFEMENDO, a recognized expert center dedicated exclusively to the treatment of endometriosis, located within Clinique Tivoli in Bordeaux. Consultations, preoperative assessment, and appointment scheduling are carried out through the IFEMENDO website.
What is bowel endometriosis?
Deep endometriosis is a condition in which tissue similar to the lining of the uterus (the endometrium) grows outside the uterus. When these lesions infiltrate the digestive tract, the condition is referred to as bowel endometriosis.
Bowel involvement is the most common non-gynecological manifestation of deep endometriosis. In the vast majority of cases, lesions are located in the rectum and sigmoid colon. Less commonly, they may affect the appendix, terminal ileum, or cecum.
Symptoms of bowel endometriosis
Symptoms are often subtle and develop gradually, sometimes remaining unnoticed for many years. They vary depending on the size and depth of the endometriotic lesions.
- Bowel habit changes: alternating diarrhea and constipation, often worsening during menstruation (catamenial symptoms).
- Dyschezia: difficulty passing stools, painful bowel movements, excessive straining, or urgency.
- Bloating and nausea: abdominal distension, nausea, and occasionally vomiting when rectal narrowing becomes significant. These symptoms may indicate an increased risk of bowel obstruction.
- Rectal bleeding: bleeding directly caused by endometriotic lesions is uncommon. In most cases, rectal bleeding is related to hemorrhoids secondary to chronic straining during defecation.
Assesment
Before any treatment decision is made, a comprehensive imaging assessment is essential to accurately map the number, location, and depth of the endometriotic lesions.
- Transvaginal ultrasound: Often the first-line imaging examination.
- Pelvic MRI: The reference imaging modality for evaluating deep endometriosis. It provides detailed information on the location, extent of disease, and relationships with adjacent organs.
Surgical treatment
Several surgical techniques may be considered depending on the characteristics of the endometriotic nodule and the patient's individual situation. The most appropriate approach is tailored to each patient and discussed during the preoperative consultation.
- Shaving : Shaving consists of carefully removing the endometriotic nodule by dissecting along its outer surface without entering the bowel lumen. The intestinal wall is preserved. This technique is generally preferred for small and superficial lesions.
- Discoid Excision : Discoid excision involves removing the full thickness of the bowel wall containing the endometriotic nodule through a controlled opening of the bowel lumen, followed by transverse closure of the healthy bowel edges. This technique allows a more complete excision than shaving while preserving the length and blood supply of the rectum.
- Segmental Bowel Resection : Segmental resection consists of removing the affected segment of the colon or rectum, including healthy margins on either side of the lesion, followed by restoration of bowel continuity with an anastomosis. It is considered the standard surgical approach for large, stenotic, or multifocal lesions.
Surgical Less Common locations - Additional surgical procedures :
- Ileocecal Resection : Performed when endometriosis involves the ileocecal junction or cecum, requiring resection followed by an ileocolic anastomosis.
- Small Bowel Resection : Rare involvement of the terminal ileum may require a segmental ileal resection.
- Appendectomy : Appendiceal endometriosis is usually treated with a simple appendectomy.