Abstract
Endometriosis is defined as the growth of endometrial glands and stroma outside the uterine cavity. Extrapelvic endometriosis is frequently seen in intestine. Intestinal endometriosis may present with colicky pain, nausea, vomit, constipation and gut obstruction which are non-specific. This article reports a case of sigmoid endometriosis. This patient presented with difficult defecation without dysmenorrhea. The result of colonoscopic biopsy and whole abdominal CT scan could not rule out sigmoid colon cancer; therefore, exploratory laparotomy was performed. From the operative finding, sigmoidectomy with end to end anastomosis and total hysterectomy with bilateral salpingo-oophorectomy were performed in the single operative session without any serious post-operative complication. Histopathological study revealed that the patient had sigmoid colon endometriosis, adenomyosis and ovarian endometriotic cyst.
Highlights
Endometriosis is defined as the growth of endometrial glands and stroma outside the uterine cavity [1]
Patients with intestinal endometriosis might present with non specific symptoms such as colicky pain, nausea, vomiting, constipation and gut obstruction [6]
Symptoms are cyclical in approximately 40% of the patients and usually aggravate during menses [19]. This patient had difficult in defecation which was one of the intestinal endometriosis symptoms but she did not have dysmenorrhea and her defecation problem was not aggravated by menstruation
Summary
Endometriosis is defined as the growth of endometrial glands and stroma outside the uterine cavity [1]. The most common site of extrapelvic endometriosis is intestine Most of these lesions are asymptomatic and often diagnosed at operative time [4,5]. Many of intestinal endometriosis patients present with gastrointestinal symptoms; radiological examination and endoscopic examination of the intestinal tract are usually performed as the initial investigation [11]. If intestinal endometriosis is identified, complete excision of the lesion offers good long term symptomatic relief. The result of colonoscopy suspected intramural mass at sigmoid colon and biopsy was performed. Operative finding revealed an intramural sigmoid colon mass which was 3x 4cm in diameter. During the follow up visit, the patient’s symptom was satisfactory relief She received post operative hormonal suppression with GnRH agonist for 6 months and add back therapy. There was no evidence of recurrence until her recent visit
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