Complex Endometriosis

Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside it. In deep infiltrating endometriosis the disease penetrates beneath the surface of pelvic organs and can involve the bowel wall, most often the rectum and sigmoid colon, and sometimes the appendix or small bowel.

Bowel endometriosis can cause painful bowel motions, particularly around a period, bleeding from the bowel, bloating, constipation or diarrhoea, and pelvic pain. Symptoms often overlap with other bowel conditions, so careful assessment is needed.

Diagnosis and planning usually involve a specialised pelvic ultrasound or MRI to map the extent of the disease and how deeply the bowel wall is involved. A colonoscopy may be arranged to exclude other causes of symptoms.

Surgery for complex endometriosis is a joint procedure in which your gynaecologist and colorectal surgeon operate together. This allows all of the disease to be treated in one operation and reduces the chance of needing a second procedure.

The technique depends on the size and depth of the bowel involvement. Smaller, superficial nodules can be shaved off the bowel surface. Deeper nodules may be removed with a disc excision, which takes a small full-thickness portion of the bowel wall and repairs it. Larger or multiple areas of disease are treated by segmental resection, in which a short section of bowel is removed and the ends rejoined.

These operations are performed laparoscopically or robotically. A temporary stoma is uncommon but is discussed beforehand for low rectal disease.

Recovery depends on the extent of the surgery, and most patients go home within a few days. Ongoing management of endometriosis, including hormonal treatment and fertility planning, continues with your gynaecologist, while your colorectal surgeon reviews your bowel recovery.