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Hum. Reprod. Advance Access published online on December 2, 2004
Human Reproduction, doi:10.1093/humrep/deh568
© 2004 by European Society of Human Reproduction and Embryology
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Received April 23, 2004
Accepted September 15, 2004

Article

The involvement of the interstitial Cajal cells and the enteric nervous system in bowel endometriosis

V. Remorgida 1*, N. Ragni 1, S. Ferrero 1, P. Anserini 1, P. Torelli 2, and E. Fulcheri 3

1 Department of Obstetrics and Gynaecology, San Martino Hospital, University of Genoa, Largo R.Benzi 1, 16132 Genoa, Italy
2 Department of General Surgery and Transplant, San Martino Hospital, University of Genoa, Largo R.Benzi 1, 16132 Genoa, Italy
3 Department of Anatomy and Histopathology, University of Genoa, Via De Toni 14, 16132 Genoa, Italy

* To whom correspondence should be addressed.
V. Remorgida, E-mail: vremorgida{at}yahoo.it


  Abstract

BACKGROUND: Our aim was to investigate the relationships between gastrointestinal symptoms and histological findings in women with bowel endometriosis. METHODS: The gastrointestinal symptoms of 362 women with endometriosis were classified according to the subgroups of the Rome II criteria. All visible endometriotic lesions of the bowel were removed; the patients were prospectively followed up for 2 years. The interstitial Cajal cells (ICC) and the enteric nervous system were immunohistochemically evaluated. RESULTS: Sixty-eight (18.8%, 95% CI 14.9-23.2) women had bowel lesions. The endometriotic lesions infiltrated the serosal layer and surrounding connective tissue in 45 cases; the subserous plexus in 11 cases; the Auerbach plexus in eight cases; the Meissner plexus in four cases. Whenever the subserous plexus was interrupted by the endometriotic lesions, the ICC were damaged. All women with endometriotic lesions reaching at least the subserous plexus reported bowel complaints. The level of infiltration into the bowel wall was correlated with severity of symptoms. Removal of lesions resulted in improvement of symptoms. CONCLUSIONS: Endometriosis-induced damage of ICC, even before muscular infiltration, may cause bowel symptoms.

Keywords: bowel endometriosis; Cajal cells; enteric nervous system.
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