確定診断から４年後に手術を施行した直腸子宮内膜症の１例

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  • A Case of Rectal Endometriosis Operated after Four Years of the Histological Diagnosis

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A 41-year-old woman complaining melena and constipation was seen at our hospital. She had been taking an LH-RH analog for the treatment of left ovarian endometriosis since 1996. She consulted a surgeon in April 1998 because of melena and constipation during menstruation. A final diagnosis of rectal endometriosis was made based on colonoscopic findings and biopsy results. An LH-RH analog was prescribed, and her symptoms improved. She experienced constipation once again in July 2002 and developed melena in August 2002. Stenosis of the rectum was confirmed by a complete examination, and surgical treatment was judged to be indicated in this case. We performed a low anterior resection combined with the removal of her uterus and both ovaries; the patient had a good postoperative recovery and was discharged on the 14th postoperative day. The histological findings showed endometriosis with strong fibrosis in the submucosal layer from the serosa of the rectum. The present case shows the need for continued follow-up since the patient's condition progress and eventually required surgery even though the intestinal endometriosis improved with hormonal therapy. Appropriate treatments should be selected based on the stage of endometriosis progression and the patient's QOL.

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