{"paper_id":"64fcc84b-0dfd-499d-8d22-84f9ddcc7445","body_text":"International Journal of Science and Research (IJSR)\n \nISSN: 2319\n-\n7064\n \nImpact Factor 2024: 7.101\n \nVolume 14 Issue 11, November 2025\n \nFully Refereed | Open Access | Double Blind Peer Reviewed Journal\n \nwww.ijsr.net\n \nA Rare Case of Descending Colon Endometriosis\n \n \nDr. Abhishekavalli J. P.\n1\n, Dr. Deepak Patkar\n2\n, Dr. Neemish Kamat\n3\n \n \nNanavati Max Superspeciality Hospital, Mumbai, Maharashtra, India\n \n \n \nAbstract\n: \nEndometriosis is the presence of functional endometrial glands and stroma outside the uterine cavity, most commonly affecting\n \nthe ovaries, uterosacral ligaments, and rectosigmoid colon. Descending colon involvement is exceptionally rare, likely due to\n \ncoel\nomic \nmetaplasia. We present a 40\n-\nyear\n-\nold woman with cyclical left flank pain and menorrhagia. MRI revealed adenomyosis and a T1 \nhyperintense lesion along the descending colon wall, further characterized on CT as a heterogeneously enhancing \nserosa\nl\n \nlesion. Surgical \nexcision confirmed endometriotic involvement. This case highlights the importance of considering bowel endometriosis in repro\nductive\n-\nage women with cyclical abdominal pain and atypical bowel lesions.\n \n \nKeywords:\n \nEndometriosis, coelomic theory, descending colon, adenomyosis, bowel endometriosis, chronic pelvic pain\n \n \n1.\n \nIntroduction\n \n \nEndometriosis affects 10\n–\n15% of women of reproductive age \nand up to 70% with chronic pelvic pain (1). Common \nlocations include the ovaries, uterosacral ligaments, and \npouch of Douglas, explained by retrograde menstruation; \nSampson’s theory\n \n(2,3). Rare extraperitoneal sites such as \nthe descending colon are attributed to \ncoelomic metaplasia\n, \nwherein mesothelial cells transform into endometrial tissue \n(4). Only two such cases have been reported worldwide (5).\n \n \n2.\n \nCase Report\n \n \nA 40\n-\nyear\n-\nold nulliparous woman presented with dull, \ncyclical left flank pain for four years, worsening during \nmenstruation, and associated with menorrhagia. She had \nknown endometriosis and adenomyosis. Examination \nrevealed left flank tenderness and a bulk\ny uterus. Laboratory \nfindings showed mild anemia.\n \n \nMRI\n \ndemonstrated a bulky, retroflexed uterus with fundal \nadenomyoma and right ovarian endometriotic cysts. A poorly \ndefined T1 hyperintense lesion (2.9 × 2.5 cm) with fat \nstranding was seen along the medial wall of the descending \ncolon. \nContrast\n-\nenhanced CT\n \nshowed a heterogeneously \nenhancing soft\n-\ntissue lesion (2.5 × 1.6 cm) on the serosal \nsurface of the descending colon (attenuation ≈ 40 HU) \nwithout luminal narrowing, consistent with endometriotic \ninvolvement.\n \n \nDespite medical therapy, symptoms persisted, and the patient \nunderwent \ntotal hysterectomy, bilateral salpingectomy, \novarian preservation, and short\n-\nsegment descending \ncolon resection with anastomosis.\n \n \nHistopathology\n \nconfirmed necrotizing granulomatous \ninflammation consistent with endometriosis.\n \n \n3.\n \nDiscussion\n \n \nBowel endometriosis involves ectopic endometrial glands \nwithin the intestinal wall or mesentery, most often affecting \nthe rectosigmoid region due to pelvic proximity and \nretrograde implantation (5). Descending colon involvement is \nrare, attributed to \ncoelomic metaplasia\n \n(4,6).\n \n \nClinical features vary from asymptomatic to cyclical \ngastrointestinal complaints including pain, altered bowel \nhabits, or rectal bleeding; often mimicking \ndiverticulitis, \nIBD, or colorectal carcinoma\n \n(7,8).\n \n \nMRI\n \nremains the imaging modality of choice for evaluating \npelvic endometriosis, while \nCT\n \nassists in assessing bowel \nwall involvement and pericolic extension (9,10). In this case, \nMRI suggested a paracolic lesion but CT provided better \nlesion delineation, guiding surgical planning.\n \n \n4.\n \nConclusion\n \n \nDescending colon endometriosis is exceptionally rare and can \nmimic other gastrointestinal conditions. Radiologists should \nconsider this diagnosis in women of reproductive age \npresenting with cyclical abdominal pain and bowel wall \nthickening, particularly w\nhen symptoms correlate with the \nmenstrual cycle.\n \n \nReferences\n \n \n[1]\n \nParasar P, Ozcan P, Terry KL. \nEndometriosis: \nEpidemiology, Diagnosis and Clinical Management.\n \nCurr Obstet Gynecol Rep. 2017;6(1):34\n-\n41.\n \n[2]\n \nSima RM, et al. \nNovel diagnosis of mesenteric \nendometrioma: Case report.\n \nMedicine (Baltimore). \n2019;98(29):\n \ne16432.\n \n[3]\n \nSampson JA. \nPeritoneal endometriosis due to the \nmenstrual dissemination of endometrial tissue into the \nperitoneal cavity.\n \nAm J Obstet Gynecol. 1927;\n \n14:422\n-\n469.\n \n[4]\n \nMeyer R. \nÜber den Stand der Frage der Adenomyositis \nund Adenomyome.\n \nZentralbl \nGynakol. 1919;\n \n43:\n \n745\n-\n750.\n \n[5]\n \nDescending Colon Endometriosis Misdiagnosed as \nDiverticulitis.\n \nJ Korean Soc Radiol. 2016;75(3):203\n-\n207.\n \n[6]\n \nNezhat C, et al. \nEndometriosis: Ancient disease, ancient \ntheories.\n \nFertil Steril. 2012;98(6):\n \nS7\n-\nS15.\n \n[7]\n \nMacafee CHG, Greer HLH. \nIntestinal endometriosis: a \nclinical and pathological study.\n \nBr J Surg. 1960;\n \n47:585\n-\n595.\n \n[8]\n \nKim JS, et al. \nIntestinal endometriosis mimicking \ncarcinoma of rectum and sigmoid colon: five cases.\n \nYonsei Med J. 2009;\n \n50:\n \n732\n-\n735.\n \nPaper ID: SR251104165745\nDOI: https://dx.doi.org/10.21275/SR251104165745\n257 \n\nInternational Journal of Science and Research (IJSR)\n \nISSN: 2319\n-\n7064\n \nImpact Factor 2024: 7.101\n \nVolume 14 Issue 11, November 2025\n \nFully Refereed | Open Access | Double Blind Peer Reviewed Journal\n \nwww.ijsr.net\n \n[9]\n \nBiscaldi E, et al. \nBowel endometriosis: CT\n-\nenteroclysis.\n \nAbdom Imaging. 2007;\n \n32:\n \n441\n-\n450.\n \n[10]\n \nYantiss RK, Clement PB, Young RH. \nEndometriosis of \nthe intestinal tract: a study of 44 cases.\n \nAm J Surg \nPathol. \nAm J Surg Pathol \n2001;\n \n25:\n \n445\n-\n454.\n \n \nFigures\n \nFigure A \n-\nT1 axial image shows Ill\n-\ndefined T1 hyperintense soft tissue lesion in left paracolic gutter adjoining descending colon.\n \nFigure B\n-\n \nCoronal T1 image shows ill\n-\ndefined T1 hyperintense soft tissue lesion.\n \nFigure C\n-\n \nT2 coronal images shows fundal adenomyoma and endometriotic cysts in right ovary.\n \nFigure D\n-\n \nT2 sagittal image shows fundal adenomyoma and pedunculated polyp.\n \nFigure E\n-\nContrast enhanced CT axial section shows nodular heterogeneously enhancing soft tissue lesion seen involving serosal \nsurface of descending colon\n \nFigure F\n-\n \nBulky uterus with heterogeneous enhancement of myometrium\n-\n \nadenomyotic.\n \n \n \nFigure A\n: \nT1 axial image shows Ill\n-\ndefined T1 hyperintense soft tissue lesion in left paracolic gutter adjoining descending \ncolon (yellow arrow), B\n-\n \nCoronal T1 image shows ill\n-\ndefined T1 hyperintense soft tissue lesion (yellow arrow).\n \n \n \nFigure C\n: \nT2 coronal images shows fundal adenomyoma (dark blue arrow) and endometriotic cysts (light blue arrow) in right \novary\n \n \n \nFigure D\n:\n \nT2 sagittal image shows fundal adenomyoma (dark blue arrow) and pedunculated polyp (green arrow)\n \n \nPaper ID: SR251104165745\nDOI: https://dx.doi.org/10.21275/SR251104165745\n258 \n\nInternational Journal of Science and Research (IJSR)\n \nISSN: 2319\n-\n7064\n \nImpact Factor 2024: 7.101\n \nVolume 14 Issue 11, November 2025\n \nFully Refereed | Open Access | Double Blind Peer Reviewed Journal\n \nwww.ijsr.net\n \n \nFigure E\n:\n \nContrast enhanced CT axial section shows nodular heterogeneously enhancing soft tissue lesion seen involving \nserosal surface of descending colon (yellow arrow). Figure F\n-\n \nBulky uterus with heterogeneous enhancement of myometrium\n-\n \nadenomyotic (red arrow).\n \n \nPaper ID: SR251104165745\nDOI: https://dx.doi.org/10.21275/SR251104165745\n259","source_license":"CC0","license_restricted":false}