28-2-2009 :The debate concerning rectosigmoid endometriosis on AAGL-ENDO-EXCHANGE automatic digest system;LISTSERV@listserv.brown.edu
We Wrote :
Our overall approach to these patients is as follows
1. If less than 50% bowel occlusion on contrast enema
- if asymptomatic and no desire to become pregnancy : do nothing (most I saw are not evolutive ; evolutivity anyway is not proven)
- if symptomatic : indication depends on the severity of pain
- if a pregnancy is planned I would be prudent since these nodules become bigger and might occasionally cause occlusion during pregnancy or ovulation induction.
2. If more than 50% bowel occlusion on contrast enema
I would be prudent since a bowel obstruction means urgent surgery in less than good circumstances. If a pregnancy is planned, I would definitively do surgery.
This however is a partial academic discussion, since more than 50% occlusion at the level of the rectosigmoid or rectum is extremely rare and all of them can be treated by discoid/full thickness excision. For the sigmoid however 50% occlusion occurs in some 10-20% and we prefer to have a sigmoid resection done.
Philippe R. Koninckx*,** and Anastasia Ussia**
*Dpt obstetrics and gynaecology, KULeuven Belgium, Univ Cattolica, Rome, Univ Oxford, UK
** Gruppo Italo-Belga, Villa del Rosario and l’Anunciatella, Rome, Italy