Authors: Yamal Patel , Kennedy Malele , Charles Muriuki , Alin Constantin , Joseph Njagi

Abstract

Background: Deep infiltrating bowel endometriosis (DIE) can result in debilitating pain, dyspareunia and infertility. Discoid full-thickness resection is a fertility-sparing option for selected rectal lesions.

Case Presentation: A 35-year-old African woman presented with severe dysmenorrhea (VAS 9/10), menorrhagia, dyschezia with alternating constipation and bloating, deep dyspareunia and infertility. Transvaginal ultrasound demonstrated adenomyosis, myoma and a 2.72 × 0.78 × 1.75 cm rectal nodule; Enzian classification: A3, B2/2, C2, FA. She underwent diagnostic hysteroscopy with hysteroscopic myomectomy, laparoscopic resection of pelvic endometriosis nodules, adhesiolysis and staged transanal double-discoid (double-disc) full-thickness excision of the rectal (lesion with a transanal circular stapler. Histopathology of the specimens confirmed endometriosis of the uterosacral and rectal lesions.

Outcome: The patient was discharged on postoperative day two, described marked symptomatic improvement at a ten-day follow-up visit, had resumed a normal diet and bowel function, and was started on suppressive hormonal therapy (dienogest). No complications were encountered.

Conclusion: Double-discoid full-thickness excision of rectal endometriosis is a feasible surgical option for selected rectal DIE nodules <30 mm depth-invasive or when lesion geometry allows; careful patient selection and operative expertise are crucial aspects.

Keywords: Bowel endometriosis, full-thickness, resection, discoid excision, case report.