Gastrointestinal endometriosis. Incidence and indications for resection.
Of 1573 consecutive patients with endometriosis diagnosed at laparoscopy or celiotomy, 85 patients (5.4%) had gastrointestinal involvement and 11 patients (0.7%) required bowel resection due to recurrent gastrointestinal symptoms (usually obstructive in nature) and/or suspicion of malignancy. Of 63 patients with gastrointestinal involvement at sites other than the appendix, who did not undergo bowel resection, only two patients had gastrointestinal symptoms at the time of diagnosis (neither patient had obstructive symptoms); follow-up has revealed that only one patient subsequently developed significant gastrointestinal symptoms. Fifteen patients had appendiceal endometriosis, but none had symptoms suggestive of appendicitis. Indications for resection of gastrointestinal endometriosis include the presence of clear-cut obstructive symptoms or the inability to exclude malignancy. The absence of gastrointestinal symptoms appears to be predictive of the absence of clinically significant intestinal endometriosis, and bowel resection is not indicated in the asymptomatic patient. Appendiceal endometriosis appears to be an incidental finding and one that is not clinically important.