Colorectal endometriosis: diagnosis and management.

Endometriosis occurs in 5 to 10% of the female population. Bowel involvemen t present in 6 to 30% of cases is predominantly localized in the pelvic par ts of the colon and rectum, close to the uterus. The goal of this work was to describe the present diagnostic and therapeutic management of deep color ectal endometriosis defined as infiltrating the digestive wall and usually requiring surgery. Colorectal endometriosis is a disabling disease. Anatomi c lesions mimic those of a cancer. Modern investigations include endorectal endosonography, recognized as the best mean to assess the depth of invasio n into the intestinal wall, and magnetic resonance imaging. Associated to e xploratory laparoscopy, these investigations allow to select the optimal op erative strategy for multifocal and complexe lesions. Surgical objective is a total resection of endometriomas, to guarantee symp tom relief and avoid recurrence. Difficulties in these procedures are usual ly due to fibrotic and vascularised lesions and associated gynaecological d isorders. In elective cases, preoperative GH-RH analog hormonal treatment m akes easier the surgical procedure. Colonic and/or rectal restorative resec tions, performed through laparoscopic approach or more frequently through l aparotomy, have to be done acccording to the usual standards of colorectal surgery. Conservative surgery of the ovaries is mandatory in premenopausal patients. (C) 2001 Editions scientifiques et medicales Elsevier SAS.