Endometriosis of GI Tract

• Endometriosis develops in 15% of females during active menstrual life

• Location (in decreasing order of frequency):

1) Ovary

2) Uterine ligaments

3) Rectovaginal septum, including sigmoid colon

4) Pelvic peritoneum

5) Umbilicus

6) Laparotomy and hernia scars

7) Appendix

• More common in nulliparous women

• More common in women who become pregnant later in life

• Symptoms

• Dysmenorrhea

• Menorrhagia

• Metrorrahgia

• Chronic pelvic pain worsened by menstruation

• Absolute or relative sterility

• Signs

• Most have no physical findings

• High association between uterine fibroids and endometriosis

• GI involvement in 12-25% of cases of endometriosis

• 85% in rectosigmoid

• 7% small bowel

• 3% rectum

• 3% appendix

Actual mucosal involvement is rare so cyclic GI bleeding is unusual

• Pathophysiology

• Repeated bleeding ‘ to fibrosis, adhesions and muscular hyperplasia of the bowel

• Most of the polypoid lesion we see is actually smooth muscle hyperplasia

• X-Ray Findings

• Four patterns, three of which simulate other diseases

¨Characteristic lesion is scalloping along the anti-mesenteric side of the colon

· Anterior scalloping of the rectum seen best on a lateral BE film is very suggestive of endometriosis of the recto- vaginal septum

¨ Polypoid lesion

¨ Long, narrowed segment like inflammatory bowel disease

¨ Short, narrow segment like carcinoma except the mucosa is intact

• Rupture of an endometrioma can ‘ adhesions and SBO as can any endometrial implant

About 1% of patients with GI endometriosis also have GU endometriosis—involving bladder, ureters and kidneys, in that order

• About 20 cases of catamenial pneumothorax, all involving the right side, most between the ages of 30-45 have been reported. Most implants were on the right hemidiaphragm, most patients had had a previous C-section, D&C, childbirth or hysterectomy.

WH/89