Editorial
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World J Gastrointest Surg. Mar 27, 2011; 3(3): 31-38
Published online Mar 27, 2011. doi: 10.4240/wjgs.v3.i3.31
Bowel endometriosis: Recent insights and unsolved problems
Simone Ferrero, Giovanni Camerini, Umberto Leone Roberti Maggiore, Pier L Venturini, Ennio Biscaldi, Valentino Remorgida
Simone Ferrero, Umberto Leone Roberti Maggiore, Pier L Venturini, Valentino Remorgida, Department of Obstetrics and Gynecology, San Martino Hospital and University of Genoa, Largo R. Benzi 1, 16132 Genoa, Italy
Giovanni Camerini, Department of Surgery, San Martino Hospital and University of Genoa, Largo R. Benzi 1, 16132 Genoa, Italy
Ennio Biscaldi, Department of Radiology, Galliera Hospital, Via Mura delle Cappuccine 14, 16128 Genoa, Italy
Author contributions: All authors contributed to writing the manuscript.
Correspondence to: Ferrero Simone, MD, PhD, Department of Obstetrics and Gynecology, San Martino Hospital, Largo R. Benzi 1, 16132 Genoa, Italy. dr@simoneferrero.com
Telephone: +39-10-511525 Fax: +39-10-511525
Received: August 29, 2010
Revised: March 14, 2011
Accepted: March 21, 2011
Published online: March 27, 2011
Abstract

Bowel endometriosis affects between 3.8% and 37% of women with endometriosis. The evaluation of symptoms and clinical examination are inadequate for an accurate diagnosis of intestinal endometriosis. Transvaginal ultrasonography is the first line investigation in patients with suspected bowel endometriosis and allows accurate determination of the presence of the disease. Radiological techniques (such as magnetic resonance imaging and multidetector computerized tomography enteroclysis) are useful for estimating the extent of bowel endometriosis. Hormonal therapies (progestins, gonadotropin releasing hormone analogues and aromatase inhibitors) significantly improve pain and intestinal symptoms in patients with bowel stenosis less than 60% and who do not wish to conceive. However, hormonal therapies may not prevent the progression of bowel endometriosis and, therefore, patients receiving long-term treatment should be periodically monitored. Surgical excision of bowel endometriosis should be offered to symptomatic patients with bowel stenosis greater than 60%. Intestinal endometriotic nodules may be excised by nodulectomy or segmental resection. Both surgical procedures improve pain, intestinal symptoms and fertility. Nodulectomy may be associated with a lower rate of complications.

Keywords: Bowel endometriosis; Diagnosis; Endometriosis; Gonadotropin releasing hormone analogue; Laparoscopy; Nodulectomy; Progestin; Colorectal resection