Colonic Endometriosis Presenting as a Sigmoid Stricture Requiring Laparoscopic Colonic Surgery for Diagnosis and Treatment

Abstract

Colonic endometriosis may be difficult to diagnose because it is relatively uncommon [1, 2], may present without stereotypic findings of symptoms related to menstruation [3], and may not be diagnosable by colonoscopy with superficial colonoscopic biopsies when endometrial implants are deep within the colonic wall [4]. An unusual case is reported in which a patient developed progressively more severe constipation leading to obstipation from partial colonic obstruction that went undiagnosed for more than 1 year despite extensive abdominal tests, including abdomino-pelvic CT, colonoscopy, and an initial laparoscopy; the etiology was definitively diagnosed as partial mechanical obstruction from colonic endometriosis after repeat laparoscopy with resection of a sigmoid stricture. This case report with literature review illustrates the potential difficulty in establishing this diagnosis, especially by colonoscopy, when endometrial lesions are deep within the colonic wall; the potential for a missed diagnosis at an initial laparoscopy; and the potential requirement for a second laparoscopy for diagnosis and treatment.