Rectosigmoid integrity after excision of nodular endometriotic disease: dowe test appropriately?

Objective To highlight the necessity of adequately testing rectosigmoid int egrity after resection of infiltrating endometriosis. Subject A 25-year-old woman with a past history of ablative treatment for e ndometriosis, symptoms suggestive of disease progression, and a palpable an terior rectal nodule. Interventions and outcomes Excisional treatment of all visible disease, inc luding the rectal nodule was carried out. Rectal integrity was confirmed in traoperatively via the 'Betadine' test. The patient presented again 3 days later with clinical findings suggestive of a bowel perforation. Repair of t he defect and a de-functioning colostomy were performed. Conclusion Although clinical bowel perforation is an uncommon event, the se quelae have far-reaching consequences for the patient's quality of life. Th e use of electrosurgical dissection may have contributed to delayed tissue necrosis and the subsequent rectal perforation. Current methods for testing colorectal integrity are reviewed.