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document Endometriosis (Chapter 20, European Manual of Medicine: Coloproctology Second Edition)

Published on 18 May 2017 By European Manual of Medicine: Coloproctology In Endometriosis

Endometriosis is the presence of endometrial-like tissue outside the uterus. It is common affecting 6–10 % of women during childbearing years and is recognized as a condition with significant social impact as related symptoms may heavily impact on patient quality of life. The digestive tract is involved in approximately one quarter of cases.

The diagnosis is suggested by the history, symptoms and physical signs and is supported by physical examination and imaging techniques (transvaginal and endorectal ultrasound, magnetic resonance and CT scan). Confirmation of the diagnosis relies on histological examination of specimens collected at time of surgery.

The etiology of endometriosis is unknown therefore treatment is not directed at a cure but at reducing related symptoms and improving quality of life. Medical treatment should be considered initially and bowel surgery should be reserved for intractable symptoms. Surgery is often very challenging because the infiltration of various structures by endometriotic nodules. The potential advantages of surgery have to be balanced with the risk of complications. Surgical treatment needs a multidisciplinary approach and a surgical team well-trained in pelvic and laparoscopic surgery. A laparoscopic approach is preferable. No clear guidelines exist concerning the relative advantages of peeling, disk or segmental resection in the treatment of intestinal nodules. Complete resection of deep infiltrative endometriosis with a low complication rate is likely to result in significant symptom improvement and quality of life in usually young patients. Therefore such surgery has to be performed in referral centres.

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