Characteristics and Surgical Outcomes of Patients with Intestinal Endometriosis Undergoing Bowel Resection.

Objective: To retrospectively evaluate the clinical features, perioperative findings, and long-term outcomes of patients who underwent bowel resection for intestinal endometriosis, and to clarify diagnostic and therapeutic challenges with the goal of supporting optimal surgical strategies that minimize recurrence while preserving function. Methods: Twenty-one patients who underwent bowel resection for intestinal endometriosis from 2002 to 2022 were evaluated regarding clinicopathological findings and short and long-term outcomes. Results: The median age was 38 years. All patients had gastrointestinal symptoms. Colonoscopy confirmed endometriosis histologically in only 1 patient (7.1%). Lesions were identified in the sigmoid colon to the upper rectum in 17 patients, some of which were accompanied by obliteration of the pouch of Douglas. Low anterior resection was performed in 15 of these patients, and temporary stomas were created in 4 patients. Gynecologic procedures were performed in 9 patients. Histopathology showed invasion into the submucosal and muscular layers. Early complications (Clavien-Dindo ≥2) occurred in 2 patients (anastomotic leak and ileus), while late complications included anastomotic stenosis, bowel stricture, and rectovaginal fistula (1 patient each). Only one recurrence (4.8%) was observed during a median follow-up of 2,088 days. Spontaneous pregnancy was achieved in 2 patients. Conclusions: This study highlights the clinical significance of bowel resection for intestinal endometriosis, suggesting the importance of comprehensive evaluation to improve diagnostic accuracy, the utility of collaboration with gynecology, and the potential for recurrence reduction and functional preservation through appropriate resection margins. These findings may contribute to the development of future treatment strategies for this condition.