LAUSR

Study Objective To present a unique case of the workup and management of recurrent colorectal endometriosis utilizing a multidisciplinary team approach. Design Case Report. Setting Community teaching hospital. Collaborative robotic surgical team including a minimally invasive gynecologic surgeon and colorectal surgeon utilizing the Da Vinci Xi platform. Patients or Participants 38-year-old gravida 3, para 1 with a history of deeply-infiltrating endometriosis status post excisional surgery including shave excision of a colorectal implant six months prior. She presents with recurrent rectal pain and bleeding due to confirmed recurrent colorectal endometriosis. Interventions Following a multi-disciplinary case conference, colorectal surgery performed a robotic-assisted low anterior bowel resection with primary colorectal anastomosis and flexible sigmoidoscopy. Gynecology was present to confirm all endometriosis excised and fertility was optimized for future planned frozen embryo transfer. Measurements and Main Results Complete excision of colorectal endometriosis with resolution of patient's rectal pain and bleeding. Pathology showed transmural colorectal endometriosis including a rectal lymph node involved with endometriosis. Conclusion Unusual case of recurrent colorectal endometriosis following shave excision, managed with segmental colorectal resection. Endometriosis involving a lymph node shows the disease's ability to be locally invasive however this phenomenon is not thought to lead to higher recurrence rates.