Multifocal Colonic Endometriosis: Diagnostic Challenge and Therapeutic Modalities

Abstract

Endometriosis occurs in 7-10% of women in the general population. It is an estrogen-dependent disease and, thus, usually affects reproductive aged women. intestinal involvement of endometriosis causing obstruction is relatively uncommon and is difficult to differentiate from neoplasia before surgery. Among women with intestinal endometriosis, the rectum and sigmoid colon are the most commonly involved areas (75–90%). We report a 22- year-old female presented with abdominal pain and rectal bleeding, and who had multifocal colonic endometriosis involving sigmoid colon and two other proximal foci (15 cm apart) diagnosed by histopathology after resection of the involved area laparoscopically with end to end anastomosis. She notices significant pain relieve one month after surgery and GnRH therapy. We did a review in the literature to find the best approach in such cases. Endometriosis is a common debilitating benign gynecologic condition. Multifocal symptomatic colonic endometriosis is rare, delayed and underdiagnosed disease. But it should be considered in the differential diagnosis of reproductive age women with cyclic abdominal pain and rectal bleeding. In this report, we present a case of young female with multifocal colonic endometriosis and discuss its clinical, radiological and colonoscopic findings. Literature review was done to find the best approach in managing such cases.