Diagnostic and treatment guidelines for gastrointestinal and genitourinary endometriosis

Abstract

Endometriosis is commonly misdiagnosed, even among many experienced gynecologists. Gastrointestinal and genitourinary endometriosis is particularly difficult to diagnose, and is commonly mistaken for other pathologies, such as irritable bowel syndrome, interstitial cystitis, and even psychological disturbances. This leads to delays in diagnosis, mismanagement, and unnecessary testing. In this review, we will discuss the diagnosis and management of genitourinary and gastrointestinal endometriosis. Medical management may be tried first, but often fails in cases of urinary tract endometriosis. This is particularly important in cases of ureteral endometriosis because silent obstruction can lead to eventual kidney failure. Thus, we recommend complete surgical treatment in these cases. Bladder endometriosis may be managed more conservatively, and only if symptomatic, because these rarely lead to significant morbidity. In cases of bowel endometriosis, we recommend medical management first in all cases, and the least invasive surgical management only if medical treatment fails. This is due to the extensive nervous and vasculature supply to the lower rectum. Injury to these nerves and vessels can cause significant complications and postoperative morbidity.

Ileal obstruction caused by transmural endometriosis in a patient with simultaneous C. difficile colitis and Influenza AH1N1. Case report

“…Endometriosis is defined by ectopic endometrium [ 2 ]. 10% of the women in reproductive age have endometriosis [ 3 ]. Etiopathogenesis is multifactorial.…”

“…From the patients with endometriosis, 10% have enterocolonic endometriosis [ 6 ]. From that subset of patients, 90% have rectosigmoid involvement [ 6 ], and only 10% of women have ileal endometriosis [ 3 ]. Most cases are asymptomatic [ 7 ].…”

Thoracic Endometriosis presented as catamental hemoptysis: Fourteen Cases of a Rare Disease and the hormonal treatment management

“…The most common anatomical location of endometriosis is pelvic cavity, and it is rarely found in extra pelvic cavity [13]. The extragenital endometriosis represents 5-12% of endometriosis [1,2] and has been reported in multiple organ and systems, such as urinary tract [14], brain [15], gastrointestinal tract [16] and lungs. Though the prevalence of endometriosis is around 15% [17], the extragenital endometriosis represents 5% of the localizations [1], and the TES is very rare [13], and it is even rarer to have TES with catamental hemoptysis as the main clinical manifestation, so the prevalence and etiology of thoracic endometriosis is unknown as most data comes from simple case reports or short series [13].…”

Rectal disc resection improves stool frequency in patients with deep infiltrating endometriosis: A prospective study

“…Gastrointestinal endometriosis is observed in up to 35–37% of women with a known diagnosis of endometriosis . It commonly occurs on the rectosigmoid colon (80%), ileum (12%), appendix or caecum (8%) . Endometrial lesions are associated with angiogenesis, nerve infiltration, fibrosis, adhesion formation and scarring leading to anatomical distortion.…”

“…Endometrial lesions are associated with angiogenesis, nerve infiltration, fibrosis, adhesion formation and scarring leading to anatomical distortion. Deep infiltrating endometriosis (DIE) of the gastrointestinal type is defined as lesions infiltrating the muscularis of the bowel . Symptoms are believed to arise from acute and chronic inflammation and the scarring that ensues.…”