Buttonhole ulceration and perforation of the rectum.

Three laparoscopies were performed with treatment of cul-de-sac endometriosis near the rectum Two patients had a subsequent laparotomy for rectal perforation. The bowel damage appears to have been from a combination of failure to appreciate the position of the bowel with anatomy distorted by endometriosis, dissecting into healthy tissue with a carbon dioxide laser, desiccating healthy tissue with bipolar electrosurgery, and thermal spread into healthy tissue from the desiccated endometriotic tissue. Gynecologists must be aware of this potential complication when treating endometriosis near the rectum.