Li Destri Giovanni, Iraci Marco, Latino Rosalia, Carastro Denise, Li Destri Marta, Di Cataldo Antonio
Dipartimento di Scienze Chirurgiche, Trapianti d'Organo e Tecnologie Avanzate, Università di Catania, Italia.
Ann Ital Chir. 2010 Sep-Oct;81(5):383-8.
Deep endometriosis is a subserosal growth (for more than 5 mm) of funzional endometrial tissue outside the uterine cavity. Authors report two clinical cases of intestinal endometriosis localized in the anterior wall of the rectum and in the last ileal loop. Both cases were characterized by sub-occlusive symptoms, diagnosis performed by laparoscopy and surgical resection. Authors focus the various pathogenetic theories and dwell itself on the symptomatology often characterized by nonspecific abdominal symptoms such as chronic abdominal pain, sometimes in relation to the menstrual cycle, and intestinal disorders. If rectal bleeding is rare, more frequent are dysmenorrhea, dyspareunia and infertility may occur in up to 50% of patients. The diagnosis of intestinal endometriosis is very difficult and can be made by radiological methods (CT or MRI) or by endoscopic ultrasound only for the rectal localization but nowadays often the diagnosis is due to laparoscopic techniques. In the absence of guidelines the surgical therapy is not well defined. When is not necessary surgical emergency, according to the depth of endometriotic infiltration, elective surgery includes several surgical techniques both conservative and extensive such as segmental intestinal resection with hysterectomy and ovariectomy. In the most recent literature, finally, are reported over 50% of pregnancies after surgery
深部子宫内膜异位症是指子宫腔外功能性子宫内膜组织的浆膜下生长（超过5毫米）。作者报告了两例肠道子宫内膜异位症的临床病例，病变分别位于直肠前壁和回肠末段。两例均以亚梗阻症状为特征，通过腹腔镜检查和手术切除进行诊断。作者着重阐述了各种发病机制理论，并详述了常以慢性腹痛等非特异性腹部症状为特征的症状学表现，有时腹痛与月经周期有关，还伴有肠道功能紊乱。直肠出血较为少见，痛经更为常见，高达50%的患者可能出现性交困难和不孕。肠道子宫内膜异位症的诊断非常困难，可通过放射学方法（CT或MRI）进行诊断，对于直肠部位的病变也可通过内镜超声诊断，但如今诊断往往依靠腹腔镜技术。由于缺乏指南，手术治疗尚无明确规范。在不需要进行急诊手术的情况下，根据子宫内膜异位症浸润的深度，择期手术包括多种保守和广泛的手术技术，如肠段切除联合子宫切除术和卵巢切除术。最后，最新文献报道手术后有超过50%的患者成功怀孕
