Endometriosis of the colon. Its diagnosis and management

Cases of endometriosis of the colon were examined in a retrospective fashion to illustrate the problems in diagnosis and management of this disease entity. Nine patients were identified from 1956 to 1988; their average age was 41 years. Common presenting symptoms were abdominal pain, diarrhea, constipation, tenesmus, small caliber stools, abdominal distention, and blood per rectum. Bowel symptoms were cyclic in four of the nine patients, and seven had a history of gynecologic complaints. Barium enema was performed in six patients and endoscopy in five patients. All cases involved the sigmoid or rectosigmoid colon. In no case was the diagnosis established endoscopically. Surgical procedures included resection with primary anastomosis (6 patients), and resection with sigmoid endcolostomy and Hartmann's pouch (3 patients). In only one case was full-thickness colonic wall involvement noted. One patient had an adenocarcinoma of the colon adjacent to the area of endometriosis. Our data indicate that the diagnosis of endometriosis of the colon should be considered in women with colonic symptoms, especially with an associated history of dysmenorrhea or cyclic changes in bowel habits. Surgical resection offers the best chance for relief of symptoms.