Rectosigmoid integrity after excision of nodular endometriotic disease: do we test appropriately?

Objective

To highlight the necessity of adequately testing rectosigmoid integrity after resection of infiltrating endometriosis.

Subject

A 25-year-old woman with a past history of ablative treatment for endometriosis, symptoms suggestive of disease progression, and a palpable anterior rectal nodule.

Interventions and outcomes

Excisional treatment of all visible disease, including the rectal nodule was carried out. Rectal integrity was confirmed intraoperatively via the ‘Betadine’ test. The patient presented again 3 days later with clinical findings suggestive of a bowel perforation. Repair of the defect and a de-functioning colostomy were performed.

Conclusion

Although clinical bowel perforation is an uncommon event, the sequelae have far-reaching consequences for the patient's quality of life. The use of electrosurgical dissection may have contributed to delayed tissue necrosis and the subsequent rectal perforation. Current methods for testing colorectal integrity are reviewed.