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Patterns of Bowel Invisible Microscopic Endometriosis Reveal the Goal of Surgery: Removal of Visual Lesions Only
- Source :
- Journal of Minimally Invasive Gynecology, Journal of Minimally Invasive Gynecology, Elsevier, 2018, 25 (3), pp.522-527.e9. ⟨10.1016/j.jmig.2017.10.026⟩, Journal of Minimally Invasive Gynecology, 2018, 25 (3), pp.522-527.e9. ⟨10.1016/j.jmig.2017.10.026⟩
- Publication Year :
- 2018
- Publisher :
- Elsevier BV, 2018.
-
Abstract
- Study Objective To document the presence of bowel invisible microscopic endometriosis implants and their relationship with deep endometriosis macronodule infiltrating the bowel. Design A series of consecutive patients with deep endometriosis infiltrating the rectum and/or sigmoid colon (Canadian Task Force classification II-2). Settings A university referral center. Patients Ten patients managed by colorectal resection. Interventions A microscopic study of endometriotic foci of the bowel involving 3272 microsection slides was established using a unique method of step serial sections using combined transverse and longitudinal macrosection. Two-dimensional reconstruction based on slide scanning highlighted the presence and localization of the deep endometriosis macronodule in contrast with bowel invisible microscopic endometriosis microimplants. Measurements and Main Results The distance separating the microimplants and the nodule and their histologic characteristics. The mean length of the colorectal specimens was 91 ± 19 mm. The maximum distance between the farthest microimplants was 7.2 cm. The maximum distance from the macroscopic nodule limit to the farthest microimplant was 31 mm. Bowel invisible microscopic endometriosis microimplants presented with similar features independently of the type of spread. They had an active appearance including stroma and glands, were sometimes decidualized, and were free of fibrosis. They were found on the distal/rectal limit of the specimen in 3 patients and on both limits (distal/rectal and proximal/sigmoid colon) in 1 patient. Conclusion Invisible microscopic endometriosis implants surround the bowel macroscopic endometriosis nodule at variable distances, suggesting that complete surgical microscopic removal may be a challenging goal. These results may help to reconsider the principles and feasibility of the surgical management of bowel endometriosis.
- Subjects :
- 0301 basic medicine
medicine.medical_specialty
Histology
Microscopic endometriosis
education
Endometriosis
Rectum
[SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics
03 medical and health sciences
0302 clinical medicine
Invisible endometriosis
Segmental resection
Colon, Sigmoid
medicine
Humans
health care economics and organizations
Sigmoid Diseases
030219 obstetrics & reproductive medicine
Task force
business.industry
digestive, oral, and skin physiology
Obstetrics and Gynecology
Sigmoid colon
[SDV.BDLR]Life Sciences [q-bio]/Reproductive Biology
Nodule (medicine)
medicine.disease
digestive system diseases
3. Good health
Surgery
Rectal Diseases
Treatment Outcome
030104 developmental biology
medicine.anatomical_structure
Referral center
Female
medicine.symptom
business
Subjects
Details
- ISSN :
- 15534650
- Volume :
- 25
- Database :
- OpenAIRE
- Journal :
- Journal of Minimally Invasive Gynecology
- Accession number :
- edsair.doi.dedup.....07427c4d596d8eba9206f0b6312786c5