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Diagnosis of intestinal endometriosis by laparoscopic surgery
February 21st, 2013

At world laparoscopy hospital, we perform all type of treatment of endometriosis by laparoscopic and robotic surgery. The role of diagnostic laparoscopy for evaluation of symptoms and clinical examination of intestinal endometriosis is very important. Other investigations are inadequate for an accurate diagnosis of intestinal endometriosis. 

How much invasion with the bowel wall by endometriosis is one factor that determines the symptoms the individual get each year. In the event the bowel endometriosis is superficial, involving only the outside serosal surface, the most typical symptoms are bloating, nausea and loose stools with menses. With the other extreme, in the event the endometriosis has invaded throughout the bowel wall, like the inside mucosa, the individual will often experience rectal bleeding along with her period. Though it may be common for endometriosis to invade through the outside serosa along with the middle muscle wall, it really is unusual to invade over the inner mucosal layer. This probably accounts for the high failure rate of barium enemas and colonoscopies in diagnosing bowel endometriosis. When the muscle wall of the bowel is a part of endometriosis, the location of the bowel may be the primary determining factor from the kind of symptoms a female experiences.

The pelvic portion of the large bowel (the rectum and the sigmoid colon) is among the most commonly involved area of the intestine. The proximity of the portion of the bowel on the vagina and cervix often ends in painful intercourse. Also, going number 2 can be be extremely painful, because the bowel contents are solid with this area of the bowel. The area of the intestine the place that the small and large bowels connect is found the area relating to the navel along with the right hip-bone. This really is from the same area because the appendix. Involvement of the bowel in this area, or with the appendix, may lead to right-sided pain. Bowel endometriosis may also result in adhesions (scar tissue formation). These adhesions can involve the ovary, fallopian tube, ureter, or another loops of bowel that can result in an incomplete obstruction (blockage) of the bowel. Adhesions could also cause pain. Endometriosis from the small bowel usually results in bloating and pain which is associated with eating. Often, patients with small-bowel endometriosis have restricted the amount and type of foods that they eat.

The signs and symptoms are slowly progressive with time, as well as the patient might not exactly even realize the extent this agreement she's got altered her diet. Small-bowel endometriosis often results in a partial bowel obstruction. Because the bowel swells carrying out a meal, the bowel kinks, and like a kinked hose, the contents do not get through until enough pressure builds to push with the narrowed portion. All of my patients going under the knife have a preoperative bowel preparation. It is usually impossible to see preoperatively if bowel endometriosis is present.

Transvaginal ultrasonography is the first line investigation in patients with suspected bowel endometriosis and allows accurate determination of the presence of the disease. Radiological techniques such as magnetic resonance imaging and multidetector computerized tomography enteroclysis are useful for estimating the extent of bowel endometriosis. Hormonal therapies significantly improve pain and intestinal symptoms in patients with bowel stenosis less than 60% and who do not wish to conceive. But when surgery commences, the laser laparoscope is a fantastic surgical instrument for the bowel endometriosis. In the vast majority of cases, this instrument supplies the magnification and precision required for me to take out the endometriosis in the bowel, without having to perform bowel resection. Within the rare cases that this endometriosis has completely replaced an area of bowel, the diseased segment of bowel will probably be removed by among the bowel surgeons in my team, and the normal ends of the bowel will probably be reconnected.
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