Laparoscopic Excision of Transmural Rectal Endometriosis.

To demonstrate the feasibility of excision of a transmural rectal endometriosis nodule and repair of the rectal defect. 26yo Gravida-0 with pelvic pain, cyclic hematochezia, and dyschezia presented with biopsy-proven rectal endometriosis. Pelvic MRI revealed a 2.3 × 2.0 × 1.8cm an endometriotic implant extending from the mesorectal fascia into the mucosa. There was also an adjacent 2.5cm endometrioma. Laparoscopic local excision was offered since the lesion was <3cm in greatest diameter, too large for discoid excision, and the procedure offered an alternative to bowel resection. Intraoperative findings were notable for an obliterated posterior cul de sac. There was a firm, 2-3cm nodule in the anterior rectum with an adjacent endometrioma. The case begins with mobilization of the ureters and the rectum bilaterally. The ultrasonic scalpel is used to dissect the rectovaginal septum and subsequently drain the endometrioma. The rectum overlying the nodule is injected with dilute vasopressin to maintain hemostasis. Cold scissors are used to open the rectal serosa, and the ultrasonic scalpel is then used to fully excise the transmural rectal nodule. Once the nodule is completely detached, it is removed through the rectal defect within in a laparoscopic specimen bag. The remaining rectal defect is closed in three layers, which involves reapproximation of the mucosa, an imbricating layer, and reinforcement of the serosa. Copious warm irrigation is performed, and a medium EEA sizer is passed through the area of the repair to ensure normal caliber. An air-leak test is negative. At her postoperative visit, the patient endorsed complete resolution of her hematochezia and dyschezia. Transmural rectal endometriotic nodules less than 3cm in size may be amenable to resection with primary repair in select patients. Preoperative bowel prep is not recommended. After closure, checking for an air-tight closure and adequate lumen caliber is essential. [ABSTRACT FROM AUTHOR]