ISSUES IN THE CLINICAL DIAGNOSIS OF BOWEL ENDOMETRIOSIS

Objective. To evaluate the clinical symptoms of bowel endometriosis and to identify a group at risk for this disease. Subject and methods. Complaints, medical history, and clinical features were analyzed in 93 patients with the verified diagnosis of bowel endometriosis. Results. The clinical forms of bowel endometriosis were identif ied as follows: 1. An aggressive form. This was typical for young women aged 18 to 25 years who had not been treated for endometriosis. In this group, the disease manifested with obvious «intestinal» symptoms (cyclic rectal bleeding, impaired passage of the intestinal contents). 2. A subtle form. This was typical for patients aged 25 to 34 years with meager clinical manifestations, in whom the clinical symptoms of bowel endometriosis were found only during an accentuated survey. This patient group showed a preponderance of complaints of infertility. Patients who had complaints associated with bowel dysfunction were not of particular concern due to their minor impact on quality of life. 3. A stenotic form. This was typical for patients aged 35 to 45 years with a long disease history who had previously received combination (medical and surgical) treatment for endometriosis. The effect of treatment was transient in all the patients. The patients commonly complained of chronic constipation, had to be on a strict diet and to constantly take laxatives, and had a complete lack of defecation and flatus during menstruation. Conclusion. The bowel endometriosis risk group comprises young patients with characteristic clinical symptoms and women with a long disease history who had been previously reoperated on for endometriosis and received ineffective medical treatment. In these patients, a directed search for bowel endometriosis should be carried out using a set of current examination techniques: ultrasonography, magnetic resonance imaging, colonoscopy, and biopsy.

bowel endometriosis, infiltrative endometriosis, cyclic rectal bleeding, endoscopic studies, ultrasonography, magnetic resonance imaging