Sigmoid Endometriosis Presenting with Colonic Obstruction after Seat Belt Trauma

Purpose: Extra-pelvic endometriosis is a rare disorder affecting pre-menopausal females. Gastrointestinal manifestations of this disease have been well characterized. However, colonic involvement with strictures has been rarely reported. A 26-year-old previously healthy female patient presented with constipation and abdominal pain after being involved in motor vehicle accident where she sustained seat belt trauma. Over the course of few months she developed symptoms of abdominal pain and bleeding per rectum along with peri-umbilical bluish discoloration at the time of her menstrual period. She was initially treated for Crohn's disease with little response. She was hospitalized later for partial colonic obstruction. A barium enema showed sigmoid stricture with proximal colonic dilation. Colonoscopy revealed a 6-cm sigmoid stricture with no mucosal abnormalities proximal to it (Fig. 1). Biopsies from the site were normal. The patient underwent exploratory laparatomy with segmental colonic resection and had an uneventful post-operative course. Histological examination confirmed the presence of endometrial-type glands extending circumferentially around the sigmoid and invading the submucosa, thus casing the stricture. The role of pelvic seat-belt trauma in triggering the endometriosis is unclear but could have well caused the spread of the disease outside the uterine cavity and into adjacent pelvic structures. The patient had no recurrence of her symptoms after the surgery on subsequent follow up. [figure 1]Figure