Colonic Endometriosis Research Articles

S2590 Fluctuating Size of Submucosal Mass in the Sigmoid Colon as a Diagnostic Clue of Colonic Endometriosis

S2590 Fluctuating Size of Submucosal Mass in the Sigmoid Colon as a Diagnostic Clue of Colonic Endometriosis

Advances in Imaging for Assessing Pelvic Endometriosis.

In recent years, due to the development of standardized diagnostic protocols associated with an improvement in the associated technology, the diagnosis of pelvic endometriosis using imaging is becoming a reality. In particular, transvaginal ultrasound and magnetic resonance are today the two imaging techniques that can accurately identify the majority of the phenotypes of endometriosis. This review focuses not only on these most common imaging modalities but also on some additional radiological techniques that were proposed for rectosigmoid colon endometriosis, such as double-contrast barium enema, rectal endoscopic ultrasonography, multidetector computed tomography enema, computed tomography colonography and positron emission tomography-computed tomography with 16α-[18F]fluoro-17β-estradiol.

S1731 Sigmoid Colon Endometriosis Masquerading as Malignancy

S1731 Sigmoid Colon Endometriosis Masquerading as Malignancy

S2538 Colonic Endometriosis Masquerading as a Colonic Mass Diagnosed With Endoscopic Ultrasound

S2538 Colonic Endometriosis Masquerading as a Colonic Mass Diagnosed With Endoscopic Ultrasound

Endometriosis pélvica extragenital como presentación de abdomen agudo obstructivo en mujer posmenopáusica. Reporte de caso

Introduction: Endometriosis isthepresence of endometrial cellsoutsidetheuterinecavity, a benigndiseasethataffectsbothwomenduringthereproductiveperiod and those in postmenopause. Extragenitalpelvic endometriosis describes endometrial lesionsthatinvolvepelvicorganssuch as therectum, sigmoid, and bladder.Clinical case: femalepatient, 71 yearsold, presents abdominal pain and changes in bowelhabits of 3 months of evolution, isadmittedwithwithclinicalpresentation of intestinal subocclusionof 5 days of evolution. Imagesreveal distal airlesswithhydro-air levels. Surgicalconduct, exploratorylaparotomy, inflammatorylesion in therectosigmainvolvingthesmallgut. Hartmann surgeryisperformed. Thepathologicalstudyreportscolonicwallwithfoci of endometriosis and adherence to theovarian and tubalparenchyma.Conclusion: Colonic endometriosis can presentwithobstruction and be difficult to differentiatefromother causes of largebowelobstruction, such as Crohn'sdiseaseorneoplasms. Sigmoid colon involvementisthemostcommon. Preoperativediagnosis duringemergencyisdifficult and dependsonthehistologicalconfirmation of theresectedspecimen.

Colonic endometriosis diagnosed by endoscopic piecemeal mucosal resection: A case report and literature review

Colonic endometriosis diagnosed by endoscopic piecemeal mucosal resection: A case report and literature review

A rare presentation of rectal endometriosis

Endometriosis is the ectopic growth of viable endometrium outside the uterus, affecting approximately 7% women. It can occur in the absence of visible pelvic disease. Most common sites are gastrointestinal and urinary tract. Common sites of involvement are rectosigmoid (51%), appendix (15%), small bowel (14%), rectum (14%), cecum and colon (5%). Cyclical hematochezia is a definitive, but rare association of intestinal endometriosis. The diagnosis of colonic endometriosis is also difficult owing to the poor diagnostic yield of colonoscopy.

Endometrioma Causing Near-Complete Obstruction of the Sigmoid Colon.

Endometriosis is characterized by extra-uterine endometrial gland and stroma implantation. Intestinal endometriosis is believed to affect about one-third of patients with endometriosis4; 72-95% of patients experience recto-sigmoid involvement.2,3 Occasionally, endometriotic lesions precipitate mass effect or infiltrate the bowel wall, mimicking a neoplasm. In the index case, we evaluated a G0P0 41-year-old perimenopausal female with near obstructing sigmoid endometrioma, clinically presented, investigated, and managed in the lines of sigmoid colon carcinoma. Computed Tomography revealed marked distention of the distal descending and proximal sigmoid colon to the level of a [possible] intraluminal mass. CA-125 was 247.4. Transvaginal ultrasound revealed a heterogeneous irregularity adjacent the left adnexa. Flexible sigmoidoscopy to 12-15 cm was unable to pass liquid or visualize the lumen secondary to extrinsic colonic obstruction. She underwent exploratory laparotomy with sigmoidectomy, oversew of rectal stump, and descending colostomy. Left fallopian tube and ovary were adherent to sigmoid mass, therefore, removed en-bloc. Histopathological report revealed extensive endometriosis involving the muscularis propria and serosal surface of colon and ovary, with fibrinous serosal adhesions of the sigmoid colon. While inconsistent clinical presentation, similar radiographic features, and colonoscopy with other inflammatory or malignant lesions of the bowel makes the preoperative diagnosis challenging, colonic endometriosis is to always be considered as one of the differential diagnoses in reproductive age women with patterned, cyclic gastrointestinal symptoms, and intestinal masses of uncertain etiology or diagnosis.

A Case of Large Bowel Obstruction- An Unusual Cause in a Middle Aged Female

Endometriosis is a disease seen among women in reproductive age group. It is characterised by deposition of endometrial tissue outside the uterus. It commonly involves the pelvic organs like ovary, fallopian tube and pelvic ligaments. Involvement of gastrointestinal tract by endometriosis is uncommon and the incidence varies widely among different studies. Colonic endometriosis can be confused as malignancy both clinically and radiologically. In these instances, histopathology is essential for a correct diagnosis. Here, the authors report a case of colonic endometriosis presenting with features of large bowel obstruction in a 49-year-old female with previous history of laparoscopic hysterectomy. Radiological scanning of abdomen and colonoscopic examination were suspicious of sigmoid malignancy. Although colonic biopsy was inconclusive and tumour markers were normal, she underwent sigmoidectomy with lymphnode clearance as per oncological principles with primary anastomosis. Her final histopathological examination revealed features of colonic endometriosis without any evidence of malignancy. Detailed evaluation of the patient didn’t reveal endometriosis at any other site. Patient was discharged after full surgical recovery and was doing well till the last follow-up.

MRI of intestinal endometriosis.

Endometriosis is a common gynecological condition of unknown etiology, which mainly affects women of reproductive age. The commonest site of gastrointestinal endometriosis is the rectosigmoid colon. Involvement of the sigmoid, cecum, appendix, and small bowel are less common, but one third of rectosigmoid endometriosis is associated with right-sided extra-pelvic bowel endometriosis. Intestinal endometriosis represents one of the most severe forms of deep endometriosis (DE). Magnetic resonance imaging (MRI) is recommended as a second-line technique in the preoperative workup of DE, especially for gastrointestinal endometriosis. An optimal MRI protocol is required for a complete mapping of endometriotic lesions. MRI could be used as a triage test in the diagnosis of rectosigmoid colon endometriosis. Magnetic resonance enterography should be additionally performed requiring a specific additional MRI protocol for the evaluation of multicentric intestinal endometriotic lesions. Except other imaging techniques, the aim of this chapter is to expose indications for MRI, technical requirements, patient preparation, MRI protocols, and criteria for the diagnosis of intestinal endometriosis.

Endometriotic rectosigmoid stricture- a rare clinical entity

Endometriosis is defined as the presence of endometrial mucosa implanted in locations other than the uterine cavity. Endometriosis is usually a disease involving women of reproductive age. A probable estimate is that 5–10% of women in their reproductive age have endometriosis. When they do occur, women experience mostly dysmenorrhea, heavy or irregular periods, pelvic pain or dyspareunia. The most common sites for endometriosis are the ovaries (60%), uterosacral ligament (60%), posterior cul-de-sac (28%), broad ligament (15%), bladder (15%) and sigmoid colon (7%). Colonic endometriosis is a rare sequelae. It usually presents vaguely with nonspecific abdominal pain, dyspareunia, tenesmus, rectal bleeding or painful defecation. Laparoscopy is considered the best diagnostic modality for endometriosis with a sensitivity of 97% and specificity of 77%. Although there are some rare cases of large bowel obstruction due to endometriosis in pre-menopausal women, it is extremely rare in the postmenopausal group. Our report highlights such a case, mimicking a malignant rectosigmoid stricture leading to a large bowel obstruction with minimal extracolonic endometriosis involvement. Conclusion: This case report shows that colonic endometriosis, although rare, can be significantly infiltrative and lead to complications such as a large bowel obstruction. Very rarely, isolated colonic involvement without pelvic endometriosis can mimic malignant obstruction as in this patient. Diagnosing this condition can be challenging and usually requires histological confirmation.

A Case of Sigmoid Colon Endometriosis Presented with Bowl Obstruction after Barium Gastrography

A Case of Sigmoid Colon Endometriosis Presented with Bowl Obstruction after Barium Gastrography

Colonic endometriosis mimicking a caecal carcinoid tumour

Colonic endometriosis mimicking a caecal carcinoid tumour

1549 Intermittent Hematochezia Due to Colonic Endometriosis

INTRODUCTION: Endometriosis is a disease defined by the presence of endometrial epithelium implanted outside of the uterus. The prevalence in reproductive age women is 10-15%, with the most common site being the ovaries. However, gastrointestinal involvement of endometriosis has been reported to occur in 3-37% of patients with endometriosis, with the rectosigmoid colon being the most common gastrointestinal site of involvement. The disease is usually diagnosed by imaging and surgical techniques whereas colonoscopy is not typically considered a mode of diagnosis for colonic endometriosis. CASE DESCRIPTION/METHODS: A 46 year old female with past medical history significant for OSA on CPAP, Secondary Polycythemia, HTN, HLD, Depression, and history of hysterectomy with tubal ligation 20 years prior presented as a referral for colonoscopy in the setting of intermittent rectal bleeding. She reported a ten month history of monthly episodic pelvic pain and mild rectal bleeding not associated with bowel movements. The timing of the bleeding was similar to her normal menstrual cycle. However, she denied vaginal bleeding and reports that she had a total abdominal hysterectomy 20 years prior due to a “cyst” on her uterus. In the 2 months prior to colonoscopy, the patient also developed some blood coating her stools intermittently during bowel movements as well. On presentation, patient's vital signs were within normal limits. Cardiac and pulmonary examination were normal. Abdomen was soft, non-tender, and non-distended with normal bowel sounds. On colonoscopy, the patient was found to have small non-bleeding external hemorrhoids, a 5 mm tubular adenoma in the transverse colon, and a 13 mm lesion in the recto-sigmoid colon that appeared to be arising from a depression in the mucosa. Initial attempt to lift lesion with 5 cc of Eleview injected into the submucosa was unsuccessful. Ultimately, the lesion was removed with hot snare. Pathology revealed endometriosis involving the mucosa and submucosa. DISCUSSION: Endometriosis is an uncommon cause of rectal bleeding. In young female patients of reproductive age, this should be on the differential. Moreover, it is important to keep this in mind in post-menopausal women as well.

1668 A Rare Cause of Cyclical Rectal Bleeding: Sigmoid Endometriosis

INTRODUCTION: Endometriosis can frequently involve the bowels with rectosigmoid involvement being the most common. Although serosal infiltration is not uncommon, mucosal involvement is rare, hence presentation with rectal bleeding is rare. Diagnosis without pathology is difficult given symptoms frequently mimic IBS, IBD or malignancy. Here, we present a case of a woman with a history of breast cancer who presented with rectal bleeding ultimately found to have infiltrating sigmoid endometriosis. CASE DESCRIPTION/METHODS: A 40-year-old woman with a history of ER+/PR-/HER2+ breast cancer in remission on maintenance tamoxifen presented with worsening rectal bleeding for one year. Interestingly, hematochezia occurred cyclically every month seemingly coinciding with menses. It was associated with dyschezia, abdominal pain, loose stools, and dysmenorrhea. Hemoglobin and rectal exam were normal. Due to her history of breast cancer, a CT scan was done which demonstrated a focal area of sigmoid wall thickening and luminal narrowing with a 3 cm × 4 cm filling defect. Primary colonic malignancy and metastatic lesions were considered in the differentials. Colonoscopy revealed an area of extreme tortuosity in the sigmoid colon that could not be traversed. Several hypervascular polypoid lesions were noted in the proximal sigmoid colon at the site of narrowing. Cold forceps biopsy of the lesions showed endometriosis on pathology. Immunohistochemical stains positive for CD10 and estrogen receptor further supported the diagnosis. The patient was treated with Goserelin acetate with complete resolution of her rectal bleeding. After a year, she discontinued Goserelin due to side effects of fatigue and joint pains and has been on Danazol suppositories. Surgery was deferred as she did not have colonic obstructive symptoms. DISCUSSION: Here, we report a rare case of sigmoid endometriosis presenting as cyclical rectal bleeding with a lesion that masqueraded as malignancy on CT scan. Gastroenterologists should be aware of this differential in women in their reproductive years and be familiar with its unusual endoscopic appearance. This case also emphasizes good history taking, where the cyclical nature of rectal bleeding coinciding with menses is a clue for diagnosis. While symptoms of colonic endometriosis are typically chronic, late diagnoses can lead to unfortunate sequelae including acute bowel obstructions. Early diagnosis is clinically important to attempt medical therapies before complications necessitate surgical intervention.

A Case of Sigmoid Colon Endometriosis Resection Diagnosed by EUS-FNA

A Case of Sigmoid Colon Endometriosis Resection Diagnosed by EUS-FNA

Healing after Resection of Colonic Endometriosis and Growth Factor–enriched Agents: An Experimental Rat Model

To examine the potential beneficial effect of platelet-rich plasma (PRP) and fibrin sealant (TISSEEL; Baxter Healthcare Corporation, Deerfield, IL) on bowel wound healing after shaving of an experimentally induced endometriotic lesion. A single-blind, randomized study (Canadian Task Force classification I). A certified animal research facility. Thirty female Sprague-Dawley rats. Experimental colonic endometriosis was induced by transplanting endometrial tissue to all animals (first surgery). Thirty rats were then randomized to 1 of 3 groups according to treatment; PRP (group 1, n = 10), fibrin sealant (group 2, n = 10), or no agent (group 3, n = 10) was applied after shaving of the endometriotic nodule (second surgery). Colonic endometriosis was successfully induced in all subjects. Four days after the second surgery, the animals were euthanized, and microscopic evaluation was performed. The pathologist was blinded to the treatment method. Histopathologic analysis revealed that compared with the control group, collagen disposition was found in a significantly higher expression in both the PRP and fibrin sealant groups (p = .011 and p = .011, respectively). Distortion of the integrity of the colon layers was statistically more pronounced in the control group compared with the fibrin sealant group (p = .033), whereas greater new blood vessel formation was observed in the fibrin sealant group compared with the control (p = .023). No histologic evidence of residual or recurrent disease was detected. Both PRP and fibrin sealant appear to be safe and associated with improved tissue healing during shaving for the excision of colonic endometriosis, attributed to the enhanced collagen disposition, neovascularization, and protection of the integrity of colon layers. Clinical trials are warranted to confirm the feasibility of PRP and fibrin sealant in the clinical setting.

Sigmoid colonic endometriosis mimicking colon cancer: A case report

Endometriosis is common in women of reproductive age, which can involve the intestinal tract. However, large bowel obstruction is an extremely rare complication of colonic endometriosis. In this article, we present a case of intestinal endometriosis with the symptom of rectal bleeding in the menstrual period for 1 year. Colonoscopy showed a semicircular tumor with luminal narrowing at rectosigmoid junction. The pathology of biopsy specimen revealed endometrial glands by repeated check after reviewing the patient's history. Surgical resection was performed because of luminal stricture. Intestinal endometriosis should always be kept in mind as a differential diagnosis in reproductive‐aged female patients who have symptoms of gastrointestinal bleeding and abdominal pain in the menstrual period.

Multifocal Colonic Endometriosis: Diagnostic Challenge and Therapeutic Modalities

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.

About a degeneration of a colon endometriosis cystic foci

About a degeneration of a colon endometriosis cystic foci