Endometriosis
Endometriosis is one of the most common causes for young women undergoing major surgery. The exact etiology is unknown but appears to be related to retrograde menstruation. The predominant symptoms are pelvic pain and infertility. Diagnosis and treatment
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Key Concepts • Endometriosis is a common cause of young women having major surgery. • Endometriosis causes infertility, pelvic pain, and dyschezia. • Laparoscopy has revolutionized the diagnosis of endometriosis. • Symptomatic endometriosis usually requires surgery. • Excision of deep pelvic endometriosis is often a combined procedure with gynecologists and urologists.
Introduction Endometriosis is a disease characterized by the presence of endometrial glands and stroma outside the uterine cavity. It is one of the most common conditions requiring surgery for women during their reproductive years. Endometriosis, while not fatal, may be associated with disabling pain and intractable infertility. The degree of symptoms varies widely and does not always correspond to the extent of pathology encountered at surgery. Small lesions may cause severe pain and infertility, while larger lesions may be asymptomatic and be found only incidentally during surgery for other diagnoses. Diagnosis is typically made or confirmed at laparoscopy or during laparotomy. Colon and rectal surgeons often become involved in the management of patients with intestinal endometriosis. This involvement may occur as a result of a combined procedure with a gynecologist or in management of an endometrioma masquerading as a neoplastic or inflammatory lesion. Treatment for endometriosis is usually multimodal and may require surgery in those patients with infertility, pelvic pain, obstruction, or a poor response to hormonal suppression. While advances in diagnostic tests and therapy have been made, endometriosis remains a frustrating
and incompletely understood disease for both the patient and her physicians.
Epidemiology The true prevalence of endometriosis is unknown. There is no noninvasive screening test for endometriosis, and its diagnosis depends on the visual or pathologic identification of implants during laparoscopy or laparotomy. Various authors have estimated that up to 15% of all women of reproductive age and one-third of infertile women have endometriosis [1, 2]. A study by Houston et al. is the only population-based study of endometriosis [3]. After reviewing the medical records for Caucasian women in Rochester, Minnesota, during the 1970s, they estimated that 6.2% of premenopausal women have endometriosis. The potential economic and societal cost of endometriosis was illustrated by the US Health Interview Survey. It found that 50% of women with endometriosis were unable to work at some time during the prior 12 months, losing an average of 17.8 days [4]. While endometriosis is primarily a disease of the reproductive years, the widespread use of exogenous estrogens and increasing obesity in our society have made it more prevalent in postmenopausal women. Conversely, there is a decrease in the incidence of the disease when women use oral contraceptives or experience multiple pregnancies [5]. These observations, coupled with the fact that the incidence of endometriosis increases over time after a woman’s last childbirth, suggest that uninter
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