Intestinal endometriosis

Introduction to intestinal endometriosis Intestinal endometriosis refers to the active function of the endometrium invading the intestine, and under the cyclical influence of ovarian hormones, a clinical symptom of non-cancerous disease, because the lesion usually invades the colon and rectum, It is called colorectal endometriosis. May be caused by multiple factors, such as menstrual blood reflux theory, body cavity epithelial metastasis theory, benign metastasis theory, genetic theory, cellular immunology. basic knowledge The proportion of illness: the probability of illness in women of childbearing age is 0.0021% Susceptible people: no specific people Mode of infection: non-infectious Complications: abdominal pain

Intestinal endometriosis

(1) Causes of the disease

Endometriosis was first reported by Roki-tansky in 1860. Meyer proposed the concept of rectal endometriosis in 1908. The cause is still unclear and may be caused by multiple factors, such as menstrual blood reflux theory. Body cavity epithelial metastasis theory, benign metastasis theory, genetic theory, cellular immunology, etc. The most supported current is Sampson's menstrual blood countercurrent theory, which is believed to be related to uterine location and menstrual blood. The number of induced abortions is related to high incidence. The late marriage and late childbirth, oral contraceptives and other factors have not yet been recognized.

(two) pathogenesis

The lesions are mostly in the intestine segment of the pelvic cavity. The left side involves the sigmoid colon and rectum. There may be purple-red nodules and adhesions in the rectum-uterine lacuna. The right side often involves the appendix and the end of the ileum. The lesion is usually located in the serosa layer. Sometimes involving the muscular layer, rarely destroying the mucosa, but transmural infiltration can lead to mucosal ulcers and perforation. The endometrium infiltrating the intestinal wall is repeatedly periodically proliferated by the influence of ovarian hormones, and the mature and functional epithelial shedding, etc. It is often the most serious before menstruation. The pain may be caused by the direct invasion of the local nerve endings by the swollen endometrial tissue. The chemical stimulation of the serosal surface by the endometrial hemorrhage and the inflammatory reaction around the lesion promote the synthesis of local prostaglandins. Factors caused by repeated necrosis and hemorrhage of the ectopic endometrium and into the abdominal cavity, eventually resulting in fibrous tissue hyperplasia, resulting in extensive adhesion of the intestinal segment to the adjacent reproductive organs, and occasionally only one or two lesions form a serosal mass, called " Endometrioma, but generally does not involve the mucosa, periodic inflammatory reactions can cause intestinal adhesions, stenosis or obstruction, in addition The proliferation of smooth muscle in the intestinal wall can also cause a narrow segment resembling a cancer. Although endometriosis is rarely malignant, it has been reported that the lesions of the colon and small intestine develop into adenocarcinoma. After menopause, these ectopic endometrium It also loses vitality, but often it has caused more serious scar tissue and affects intestinal function.

Intestinal endometriosis prevention

1. Progesterone drugs for girls with a family history of obvious ectopic disease, after the menstrual rule begins to ovulate, progesterone drugs can be given periodically to inhibit the occurrence of endometriosis.

2. Treatment of menstrual blood retention disease as soon as possible to treat some diseases that may cause menstrual blood retention or poor drainage, such as hymen no hole, vaginal atresia or scar stenosis, cervical atresia, uterine extreme flexion.

3. Age-appropriate marriage and drug contraceptive pregnancy can delay the occurrence and development of ectopic disease. For women who are already married or have dysmenorrhea after marriage, they should be married and ill. If they have children, long-term use of contraceptive pills to inhibit ovulation can promote endometrium. Atrophy and decreased menstrual flow, so the chance of ectopic disease caused by menstrual blood and endometrial debris flowing back into the abdominal cavity is also reduced.

4. Prevention of iatrogenic endometrial implantation

(1) before menstruation, after menstruation or diagnostic curettage, should avoid tubal ventilation, water or uterine tubal iodine angiography to prevent the endometrium into the pelvic cavity.

(2) Cervical electric ironing, cryotherapy and other minor operations should be implemented as soon as possible after menstruation, so as to avoid the endometrium that has not healed in the next menstrual period, which causes the endometrium to fall off, and should avoid the electric iron during surgery. Or the freezing head enters the neck tube too deep to prevent postoperative neck stenosis.

Intestinal endometriosis Complications, abdominal pain

1. Intestinal hemorrhage is more common in the endometriosis of the mucosal penetration or ischemic necrosis of the intestinal wall fibrosis, although mucosal inflammation is rare, once it can cause ulcers and bleeding.

2. Intestinal endometriosis cecal involvement is rare, occasionally right lower abdominal pain, and jam-like stool caused by ischemic ulcer caused by incomplete nesting of the cecum and colon.

Intestinal endometriosis Symptoms Common symptoms constipation abdominal pain lower abdominal pain dysmenorrhea endometrial obstruction uterine stenosis ring gastrointestinal symptoms diarrhea blood in the stool

The disease is usually only seen in women with active ovarian function, so it is more common in the 20 to 45 years old, 2 / 3 is not maternal, the symptoms of postmenopausal women are often caused by the previous scar or the application of exogenous estrogen In addition to gastrointestinal manifestations, patients are often accompanied by gynecological symptoms such as dysmenorrhea, menstrual disorders, dyspareunia and infertility. Although 30% to 95% of patients lack specific gastrointestinal symptoms, they often receive abdominal cavity. Mirror or laparotomy was accidentally found in small ectopic tissue lesions confined to the serosal surface, but if constipation or diarrhea, abdominal pain, anal pain during defecation, or lower back pain and blood in the stool, suggesting that there may be distal colon involvement. Endometriosis is best developed in the rectum and sigmoid colon, accounting for 75% to 90% of the intestinal involvement, about 63% of the endometriosis of the appendix is lacking, and about half of the symptoms are acute and acute. Appendicitis is similar, endometrial obstruction, cecal involvement is rare, occasionally right lower abdominal pain, and jam-like stool caused by ischemic ulcer caused by incomplete nesting of the cecum and colon.

Examination of intestinal endometriosis

In view of the possible autoimmune dysfunction in patients with endometriosis, the endometrial antibody (EM-Ab) in patients is often elevated, but it is similar to CA125, with limited specificity, and any epithelial lesions. Can also be positive, such as combined with medical history, especially progressive dysmenorrhea, EM-Ab measurement is helpful for the diagnosis of this disease.

1. X-ray barium enema angiography depends on the degree of infiltration of the lesion on the intestinal wall, manifested as extraintestinal compression, intestinal wall or intestinal cavity filling defect, but the most common extraintestinal compression, the disease features less X-ray performance However, in patients with typical sites, combined with medical history may still be diagnosed.

The typical manifestation of this disease is that the intestinal lumen is irregularly narrow, and there is no clear boundary with the normal intestinal segment. The diseased intestine is generally 2 to 5 cm. There are often polypoid changes of different sizes in the narrow intestinal lumen. Examination showed that the mucosa of the intestinal segment was in the shape of a sac, and the anterior wall of the intestine that formed the rectal uterus was more obvious, and often had a constant curved impression, which was caused by a sticky mass or uterus compression. Gordon believes that the sacral mucosa Morphology may be the only X-ray manifestation of EM invading the intestinal wall, and it may also help to detect missing small intestine or small intestine wall. He also suggested that only the compression of the extraintestinal mass may not have intestinal wall infiltration, such as At the same time, the presence of the sacral mucosa is a reliable basis for EM to invade the intestinal wall.

2. Most of the colonoscopy can be found that the intestinal stenosis or compression without ulceration, there are erosions in the external pressure of the blood in the stool, and more than half of the biopsy can be diagnosed.

3. Laparoscopy can be used to observe not only the lesions on the serosal surface but also the biopsy.

4. Image examination Ultrasound and CT examinations are helpful for finding the location, size and extent of the lesion.

Diagnosis and diagnosis of intestinal endometriosis

The disease is easily confused with rectal sigmoid colon cancer. The latter is characterized by localized stenosis of the diseased intestine, clear boundary with the normal intestinal segment and mucosal destruction, and progressive progressive aggravation of the symptoms. The pelvic implant of the metastatic tumor of the abdominal cavity can also be used. It produces similar changes to the disease, but it is often accompanied by different degrees of ascites and/or the presence of primary lesions. Chronic colitis, rectal sigmoid radiofrequency contraction after radiotherapy in the pelvic region can sometimes be misdiagnosed as this disease. .

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