Aggiornamento 2010 – Pagina 2

Aggiornamento Bowel Endometriosis

del 2-5-2010


G Chir. 2010 Mar;31(3):100-2.

Occlusione intestinale acuta da endometriosi ileale trattata in laparoscopia. Case report.

[Article in Italian]

Feroci F, De Prizio M, Kröning KC, Moraldi L, Scatizzi M.

Verisione italiana Riassunto: Occlusione intestinale acuta da endometriosi ileale trattata in laparoscopia. Case report. F. Feroci, M. De Prizio, K.C. Kröning, L. Moraldi, M. Scatizzi Il 10-20% delle donne in età fertile è affetto da endometriosi. La sua localizzazione ileale, solitamente nel tratto terminale, è solo del 7%. L’occlusione intestinale si verifica in non più dello 0,15% delle pazienti affette da endometriosi. Presentiamo un caso di occlusione intestinale acuta da endometriosi ileale, in una donna di 39 anni, in cui l’approccio diagnostico e terapeutico è stato condotto per via laparoscopico. English version Summary: Laparoscopic approach in acute bowel obstruction due to ileal endometriosis: case report. F. Feroci, M. De Prizio, K.C. Kröning, L. Moraldi, M. Scatizzi Endometriosis affects 10-20% of fertile women, and in 3-37% of them it extends to the bowel. Its location, in the ileal tract of the bowel, usually the end-part, is only the 7%; and the occurrence of intestinal obstruction is no more than 0.15% of patients affected by endometriosis. We present a case of acute bowel obstruction due to ileal endometriosis in a 39 years woman, diagnosed and treated by laparoscopic approach.

N Z Med J. 2010 Apr 9;123(1312):77-80.

Non-classic congenital adrenal hyperplasia due to 21-hydoxylase deficiency as a cause of infertility and miscarriages.

Falhammar H.

Department of Endocrinology, Cairns Base Hospital, PO Box 902, Cairns, QLD 4870, Australia.

The extragonadal manifestations of intestinal endometriosis necessitating immediate abdominal surgical exploration are, to date, sparsely represented within the literature. We present two cases of acute complete small and large bowel obstruction secondary to endometriosis, requiring emergent laparotomy; and review the pertinent literature.

Reprod Biomed Online. 2010 May;20(5):602-609. Epub 2010 Feb 1.

Fertility and clinical outcome after bowel resection in infertile women with endometriosis.

Stepniewska A, Pomini P, Scioscia M, Mereu L, Ruffo G, Minelli L.

Department of Obstetrics and Gynecology, Ospedale Sacro Cuore, Via Don Sempreboni 5, 37024 Negrar, Verona, Italy.

Bowel resection for endometriosis improves pain symptoms and quality of life in symptomatic women. However, little is known about fertility after surgery, particularly after such treatment in women suffering from infertility. The aim of the present study was to evaluate post-operative fertility and long-term clinical outcome after laparoscopic colorectal resection for endometriosis in infertile women. This study reports clinical outcomes in 62 infertile women who underwent laparoscopic excision of endometriosis with segmental bowel resection performed for severe intestinal symptoms. Among women younger than 30years trying to conceive spontaneously, the cumulative pregnancy rate was 58% and the cumulative pregnancy rate was 45% in those aged 30-34 years. The total pain recurrence was 9.7% (six cases) and endometriosis recurrence was diagnosed by ultrasound in 14.5% (nine cases) during the follow-up period. Four of these patients needed further surgery because of severe symptoms. The surgical treatment of bowel endometriosis seems to improve pain symptoms and patients’ satisfaction rates, and it could also be indicated in infertile women. Copyright © 2010 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Eur J Obstet Gynecol Reprod Biol. 2010 Mar 11. [Epub ahead of print]

Letrozole and norethisterone acetate in colorectal endometriosis.

Ferrero S, Camerini G, Ragni N, Venturini PL, Biscaldi E, Seracchioli R, Remorgida V.

Department of Obstetrics and Gynaecology, San Martino Hospital and University of Genoa, Largo R. Benzi 1, 16132 Genoa, Italy.

OBJECTIVE: Up to now limited attention has been given to the medical treatment of bowel endometriosis. This study evaluates the efficacy of aromatase inhibitors and norethisterone acetate in treating pain and gastrointestinal symptoms caused by bowel endometriosis. STUDY DESIGN: This prospective pilot study included six women with colorectal endometriosis; all women had intestinal nodules infiltrating at least the muscularis propria of the bowel and did not have a stenosis of the bowel lumen >60%; the patients suffered from pain and intestinal symptoms. The study subjects received letrozole (2.5mg/day) and norethisterone acetate (2.5mg/day) continuously for 6 months. The presence and intensity of symptoms were evaluated before starting the treatment, and after 3 and 6 months of treatment. RESULTS: The double-drug regimen improved pain, non-menstrual pelvic pain, deep dyspareunia, dyschezia, symptoms mimicking diarrhoea-predominant irritable bowel syndrome, intestinal cramping, abdominal bloating and passage of mucus in the stools, and 67% of the patients declared that the treatment improved their gastrointestinal symptoms. CONCLUSIONS: The administration of letrozole and norethisterone acetate reduces pain and gastrointestinal symptoms of women with colorectal endometriosis, particularly when patients suffer from symptoms mimicking diarrhoea-predominant irritable bowel syndrome. Copyright © 2010. Published by Elsevier Ireland Ltd.

JSLS. 2009 Oct-Dec;13(4):496-503.

Laparoscopic excision of endometriosis may require unilateral parametrectomy.

Landi S, Mereu L, Indraccolo U, Favero R, Fiaccavento A, Zaccoletti R, Clarizia R, Barbieri F.

Department of Obstetrics and Gynecology, Ospedale Sacro Cuore, Verona, Italy.

OBJECTIVE: We investigated the effects of laparoscopic excision of endometriosis with unilateral parametrectomy on bladder, rectal, and sexual function as well as patient satisfaction. METHODS: Women who underwent this procedure between February 1, 2006 and November 15, 2007 were enrolled. Patient characteristics, pre- and postoperative findings, and follow-up data were retrospectively collected from a computerized database. RESULTS: Twelve patients were enrolled in the study. All of the symptoms except dysuria improved after surgery, worsening long after the operation. It seems that all parameters including sexuality, micturition, and defecation are equally important in regards to the final judgement of satisfaction, with a trend towards amelioration long after the operation. CONCLUSIONS: Unilateral parametrectomy may offer successful results in terms of patient satisfaction despite some impairment in bladder, bowel, and sexual function. The risk of permanent functional impairment is high; therefore, surgeons need to maintain the integrity of the contralateral nerve pathway. This is highly important, because pain relief seems to be partially involved in the final judgement of postoperation satisfaction.

Eur J Gastroenterol Hepatol. 2010 Mar;22(3):374-5.

Ileal intubation with a transnasal endoscope.

Pietropaolo V, Hassan C, Pontone S, Onorato M, Pedretti G, Zullo A.

Digestive Endoscopy Unit, La Sapienza University, Rome, Italy.

Transnasal upper endoscopy has been implemented in the last decade as it is perceived as less fastidious than peroral endoscopy, and small-caliber gastroscopes are widely available in the endoscopic centres. We report the feasibility of performing a full colonic study with ileal intubation, using a small-caliber endoscope commonly used for transanal endoscopy, after failing with a standard gastroscope.

World J Gastroenterol. 2010 Feb 7;16(5):648-51.

Rectal perforation from endometriosis in pregnancy: case report and literature review.

Pisanu A, Deplano D, Angioni S, Ambu R, Uccheddu A.

Department of Surgery, Clinica Chirurgica, University of Cagliari, Ospedale San Giovanni di Dio, Via Ospedale 46, 09124, Cagliari, Italy.

This case report describes a woman with spontaneous rectal perforation from decidualized endometriosis in pregnancy. A 37-year-old woman was admitted to our hospital at 30 wk of pregnancy with symptoms suggestive of pyelonephritis, which persisted until 33 wk of gestation when delivery of a premature male baby was performed through a cesarean section. On postoperative day 2, an abdominal computed tomography showed free air in the peritoneal cavity and a pelvic abscess. Explorative celiotomy revealed a diffuse severe fecaloid peritonitis that originated from a 3-cm wide rectal perforation. A Hartmann operation was then performed. Histopathological findings were consistent with decidualization of the rectal wall. Only 20 cases of intestinal perforation due to endometriosis have been reported in the literature. This report is believed to be the first case of spontaneous rectal perforation from endometriosis in pregnancy, and it shows the potential occurrence of serious and unexpected complications of the disease.

Praxis (Bern 1994). 2010 Feb 3;99(3):200-2.

CME–ultrasound diagnosis. Dysuria in a young woman.

[Article in German]

Tuma J, Trinkler F.

Präsident Ausbildungskommission, Schweizerische Gesellschaft für Ultraschall in der Medizin, Seilweg 1, 8610 Uster.