Human Reproduction, Vol. 18, No. 6, 1323-1327,
June 2003
© 2003 European Society of Human Reproduction and Embryology
Histopathological extent of rectal invasion by rectovaginal endometriosis
Department of Obstetrics and Gynecology, Friedrich Schiller University, Bachstrasse 18, 07740 Jena, Germany
1 To whom correspondence should be addressed. e-mail: Achim.Schneider{at}med.uni-jena.de
BACKGROUND: We aimed to evaluate the microscopic extent of endometriosis in surgical en-bloc specimens of vaginal skin, rectovaginal septum, cul-de-sac, and part of the rectosigmoid bowel. METHODS: From December, 1997 to October, 2001, 50 patients with the trias of intestinal pain, palpable disease in the rectovaginal septum, and laparoscopic diagnosis of endometriosis of the cul-de-sac and/or rectosigmoid colon underwent combined laparoscopic–vaginal en-bloc resection of the cul-de-sac with partial resection of the posterior vaginal wall and rectum with reanastomosis by minilaparotomy. All surgical specimens were histopathologically evaluated in a standardized fashion. RESULTS: The mean length of the bowel specimen was 7.48 cm. Endometriosis involved the serosa and muscularis propria in all patients, the submucosa in 17 patients (34%), and the mucosa in five patients (10%). After a mean follow-up of 32 months, 90% of patients reported a considerable improvement or were completely free of symptoms and the rate of recurrence was 4% (two patients). CONCLUSIONS: Partial bowel resection indicates the depth and multifocality of endometriosis affecting the recto-sigmoid colon. Such extensive surgery appears justified by the extent of the lesions and the long-term relief of symptoms achieved.
Key words: histopathological evaluation/rectovaginal endometriosis
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