Deeply infiltrating endometriosis affecting the rectum and lymph nodes

Objective To analyze morphologic aspects of bowel endometriosis. Design Prospective study of 35 consecutive cases of bowel endometriosis. Setting Multidisciplinary group practice and teaching hospital. Patient(s) Thirty-five patients with bowel endometriosis were assessed between September 2003 and June 2005. Intervention(s) Histologic analysis of 35 tissue samples removed at laparoscopic rectosigmoidectomy. Main Outcome Measure(s) We performed an evaluation of lesion size, number of lesions present in the bowel, intestinal wall layers affected by the endometriotic lesion, circumference of the intestinal loop affected by the endometriotic lesion, and presence of lymph nodes with foci of endometriosis. Result(s) Analysis of the surgical samples revealed lymph nodes in the pericolic adipose tissue of 19 (54%), cases and in 5 of these cases (26.3%), endometriosis had affected the lymph nodes. When the thickness of the endometriotic lesion reached 1.75 cm, lymph nodes of all patients were affected, and all patients in whom more than 80% of the circumference of the intestinal loop was affected by endometriosis presented with positive lymph nodes. Conclusion(s) This study raises doubts about whether this form of the disease can still be considered a clinically benign disease.