Sigmoid endometriosis

Abstract

A 33-year-old woman presented with constipation that had progressively worsened over a period of 10 months (stool frequency once per week). She also complained of mild epigastric pain that was unrelated to menses. Examination was unremarkable. Transabdominal US, CT, and magnetic resonance imaging of the abdomen and the pelvis were negative. Colonoscopy revealed a subtle irregularity of the mucosal folds in the distal sigmoid colon (A) that become more obvious with the application of indigo carmine dye (B). Histopathologic assessment of multiple biopsy specimens was inconclusive. EUS demonstrated a focal, hypodense lesion, 22 × 17 mm, involving the muscularis propria and serosa but not the submucosa (C), findings that were interpreted as suggestive of endometriosis. The involved segment of sigmoid colon was surgically resected. Histopathologic assessment of the resection specimen revealed endometrial glands and stroma in the muscle layer of the sigmoid colon (D; H&E, orig. mag. ×100), thereby confirming the diagnosis of sigmoid involvement by endometriosis. View Large Image Figure Viewer Download Hi-res image View Large Image Figure Viewer Download Hi-res image View Large Image Figure Viewer Download Hi-res image