Sub-occlusione intestinale da insospettata endometriosi rettale ed ileale. Due casi clinici e revisione della più recente letteratura.


COD: 05_2010_383-388 Categorie: ,

Giovanni Li Destri, Marco Iraci, Rosalia Latino, Denise Carastro, Marta Li Destri, Antonio Di Cataldo

Ann. Ital. Chir., 2010 81: 383-388

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Deep endometriosis is a subserosal growth (for more than 5 mm) of funzional endometrial tissue outside the uterine cavity.
Authors report two clinical cases of intestinal endometriosis localized in the anterior wall of the rectum and in the last
ileal loop. Both cases were characterized by sub-occlusive symptoms, diagnosis performed by laparoscopy and surgical resection.
Authors focus the various pathogenetic theories and dwell itself on the symptomatology often characterized by nonspecific
abdominal symptoms such as chronic abdominal pain, sometimes in relation to the menstrual cycle, and intestinal
disorders. If rectal bleeding is rare, more frequent are dysmenorrhea, dyspareunia and infertility may occur in up to 50%
of patients.
The diagnosis of intestinal endometriosis is very difficult and can be made by radiological methods (CT or MRI) or by
endoscopic ultrasound only for the rectal localization but nowadays often the diagnosis is due to laparoscopic techniques.
In the absence of guidelines the surgical therapy is not well defined. When is not necessary surgical emergency, according
to the depth of endometriotic infiltration, elective surgery includes several surgical techniques both conservative and
extensive such as segmental intestinal resection with hysterectomy and ovariectomy.
In the most recent literature, finally, are reported over 50% of pregnancies after surgery.