Endometriosis is a condition that affects many women across the globe, and when it involves the bowel, it becomes an even more complex issue. Bowel resection endometriosis is a surgical procedure to remove parts of the bowel affected by endometriosis. This comprehensive guide aims to help readers understand this condition, its symptoms, diagnostic procedures, and treatment options.
What is Bowel Endometriosis?
Bowel endometriosis describes a situation where endometriosis, a condition characterized by the growth of endometrial-like tissue outside the uterus, affects the bowel on a superficial or deep level. This form of endometriosis often results in bowel symptoms and can impact the patient’s overall quality of life.
Read More: Can bowel endometriosis cause cancer
Prevalence of Bowel Endometriosis
Approximately 10% of all women between 15-50 years old suffer from endometriosis, with bowel endometriosis constituting a significant portion of these cases. Up to 15% of patients with endometriosis have bowel involvement. About 90% of bowel endometriosis cases involve the rectum or sigmoid colon.
Symptoms of Bowel Endometriosis
Bowel endometriosis can present a variety of symptoms, some of which are:
- Pain during bowel movements
- Deep pelvic pain during sexual intercourse
- Constipation or diarrhea
- Abdominal bloating
- Rectal bleeding during menstrual periods
- Feeling of incomplete evacuation
However, it’s important to note that these symptoms may vary with each individual and may intensify during the menstrual cycle.
Read More: Intestinal Endometriosis: A Brief Introduction
Diagnosis of Bowel Endometriosis
Accurate diagnosis of bowel endometriosis requires a multidisciplinary approach involving imaging techniques and exploratory laparoscopy, which is considered the gold standard for diagnosing endometriosis.
Imaging Techniques
Imaging techniques used in the diagnosis of bowel endometriosis include:
- Transvaginal Ultrasound: This non-invasive tool allows the detection of deep endometriosis as a heterogeneous, hypo-echoic mass.
- Barium Enema Examination: This examination is crucial in determining the extent of the disease. It reveals an extrinsic mass compressing the bowel lumen and fine crenulation of the mucosa in the specific region.
- Magnetic Resonance Imaging (MRI): MRI provides detailed images of the pelvis, aiding in the diagnosis of multifocal endometriosis and defining the condition’s anatomical location.
Exploratory Laparoscopy
Exploratory laparoscopy allows for the examination of the uterus, uterosacral ligaments, ovaries, ureters, sigmoid colon, upper rectum, and other areas. This procedure should be performed by an experienced gynecologist in cooperation with a colorectal surgeon.
Treatment Options for Bowel Endometriosis
The treatment of bowel endometriosis typically involves a combination of hormonal therapies and surgical interventions.
Read More: What are the treatment options for Endometriosis?
Hormonal Therapies
Hormonal treatments can reduce or stop ovulation, allowing the endometriosis to shrink by decreasing hormonal stimulation.
Surgical Interventions
Surgery aims to cut out (excise) or destroy (ablate) as much of the endometriosis as possible. The type of surgery performed depends on the extent and location of the endometriosis. Surgical options include:
- Shaving: This technique involves cutting off the endometriotic nodule without opening the intestinal lumen.
- Disc Resection: For deeper nodules of endometriosis, a disc of bowel wall can be removed, and then the hole closed with stitches or staples.
- Segmental Resection: This involves the removal of a segment of the bowel and then re-joining the two ends of the bowel.
Outcome of Multidisciplinary Surgery
The outcome of radical endometriosis surgery is evaluated based on symptom control, recurrence rate, and pregnancy. Overall, most studies show an improvement in pain, and gynecological and intestinal symptoms after bowel resection. A favorable outcome is more achievable by having a multidisciplinary team, including a general surgeon or colorectal surgeon, in the operation to help with the bowel resection.
Conclusion
Bowel resection endometriosis is a complex surgery that requires a multidisciplinary approach for effective treatment. It’s crucial for patients to understand the nature of the condition, the diagnostic procedures involved, and the potential treatment options available. By working closely with a team of medical professionals, patients can successfully manage bowel resection endometriosis and improve their quality of life.
References:
https://academic.oup.com/humrep/article/21/5/1243/987312
https://www.chelwest.nhs.uk/your-visit/patient-leaflets/medicine-services/bowel-endometriosis
Bowel Endometriosis Surgical Treatment
https://www.sciencedirect.com/science/article/pii/S1521693420300857