Outlet constipation syndrome caused by elongation of the rectosigmoide as a frequent etiology for pelveo-abdominal pain and intestinal troubles in women with endometriosis

Abstract

The aim of the study was to isolate from the clinical history and examination, symptoms, or combination of symptoms highly suspicious for intestinal infiltration in endometriosis patients. In a prospective study, preoperative anamnesis on defecation problems and pain symptoms was correlated with the vaginal examination and the laparoscopic findings in 2,000 consecutive patients with suspicion of intestinal endometriosis; 65.7% of the patients reported a typical symptomatology combining left-sided pelvic pain irradiating systematically to the back and occasionally to the left leg, with dyschesia, abdominal bloating, and/or sensation of a doubt masse in the left lower or middle abdomen, sometimes rectorrhagia and an improvement in the pain after defecation. In the absence of a palpable endometriotic nodule of the rectovaginal space, the combination of this symptoms correlated in 93.7% of the patients with an outlet constipation syndrome due to a significant elongation with kinking of the rectosigmoide. In the patients with a palpable endometriotic nodule of the posterior fornix (n=712), the combination of an apareunia with the apparition of constipation for 2-3 days at the beginning of the period bleeding followed by a diarrhea until the end of the period shows a positive predictive value for deep intestinal infiltration of 95%. In all endometriosis patients undergoing a laparoscopy for pain and intestinal disorders, the elongation of the rectosigmoide must be perceived and recognized as a potential cause for an outlet constipation syndrome which can be cured easily by a leftsided sigmoidopexy. In patients with a macroscopic endometriotic nodule of the posterior fornix, the presence of an apareunia and the apparition of constipation at the beginning of the menstruation followed 2-3 days later by a diarrhea are strong arguments for an invasive intestinal endometriosis, and those patients must be primarily referred to a tertiary referral center.