Endometriosis

• Endometriosis develops in 15% of females during active menstrual life

• Location  (in decreasing order of frequency):

                    1) Ovary

                    2) Uterine ligaments

                    3) Rectovaginal septum, including sigmoid colon

                    4) Pelvic peritoneum

                    5) Umbilicus

                    6) Laparotomy and hernia scars

                    7) Appendix

• More common in nulliparous women

• More common in women who become pregnant later in life

• Symptoms

                    • Dysmenorrhea

                    • Menorrhagia

                    • Metrorrahgia

                    • Chronic pelvic pain worsened by menstruation

                    • Absolute or relative sterility

• Signs

      • Most have no physical findings

      • High association between uterine fibroids and endometriosis

• GI involvement in 12-25% of cases of endometriosis

      • 85% in rectosigmoid

      • 7% small bowel

      • 3% rectum

      • 3% appendix

• Actual mucosal involvement is rare so cyclic GI bleeding is unusual

• Pathophysiology

      • Repeated bleeding leads to fibrosis, adhesions and

muscular hyperplasia of the bowel

       • Most of the polypoid lesion we see is actually smooth muscle hyperplasia

Imaging Findings

       • Four patterns, three of which simulate other diseases

• ¨Characteristic lesion is scalloping along the anti-mesenteric side of  the colon

• Anterior scalloping of the rectum seen best on a lateral 

BE film is very suggestive of endometriosis of the

recto- vaginal septum

¨ Polypoid lesion

¨ Long, narrowed segment like inflammatory bowel disease

¨ Short, narrow segment like carcinoma except the mucosa is intact

                    • Rupture of an endometrioma can leading to

adhesions and SBO as can any endometrial implant

• About 1% of patients with GI endometriosis also have GU endometriosis—involving bladder, ureters and kidneys, in that order

• About 20 cases of catamenial pneumothorax, all involving the right side, most between the ages of 30-45 have been reported.  Most implants were on the right hemidiaphragm, most patients had had a previous C-section, D&C, childbirth or hysterectomy.