Decoding the Overlap: Imaging the Crossroads of Endometriosis and Inflammatory Bowel Disease

Gastrointestinal tract, Genital / Reproductive system female, CT, MR, MR-Enterography, Diagnostic procedure, Surgery, Inflammation Authors: I. Espallargas Giménez, O. Busquets Carrera, G. Casamayor López, I. Jiménez Sosa, D. Durany Lara, B. Bové, C. Martinez-Alvez, I. Tapiolas DOI: 10.26044/ecr2025/C-12888 Learning objectives To understand and distinguish between the shared radiologic features of endometriosis and inflammatory bowel disease (IBD) while identifying subtle differences to improve diagnostic accuracy. To analyze retrospective cases where both endometriosis and IBD were diagnosed, including instances confirmed post-surgery.

Available evidence indicates an increased risk of developing inflammatory bowel disease in patients with endometriosis, likely related to the dysregulation of the immune response. Similar gastrointestinal symptoms between endometriosis and IBD pose a significant challenge in accurately diagnosing and managing young women presenting with abdominal pain. Additionally, there is a tendency to attribute new findings to known diseases in these patients, which can further complicate accurate diagnosis.To address these diagnostic challenges, patients underwent CT, MRI, or both before the diagnosis was confirmed. Findings and procedure details The ChallengeThe gastrointestinal tract is the most frequent extragenital location for endometriosis. Bowel endometriosis is usually characterized by a solitary nodule larger than 1 cm in diameter, often penetrating the bowel's muscular layer and nearby structures, with mucosal involvement occurring in only 10% of cases. This condition affects approximately 5% to 12% of women with endometriosis, with isolated digestive endometriosis, defined by the absence of pelvic disease involvement, observed in 20% of cases.The rectum and sigmoid colon are the primary sites for endometriosis outside the...

A multimodal imaging approach is crucial in the evaluation of pelvic pain. Optimizing and adapting MRI enterography protocols to better detect signs of endometriosis may improve diagnostic accuracy, particularly in patients with inflammatory bowel disease.Advanced imaging should also be considered for female patients of reproductive age diagnosed with Crohn's disease to rule out endometriosis, not only due to the overlap in gastrointestinal and pelvic symptoms but also because of the increased risk of both diseases coexisting. Personal information and conflict of interest I. Espallargas Giménez: Nothing to disclose O. Busquets Carrera: Nothing to disclose G. Casamayor López: Nothing to disclose I. Jiménez Sosa: Nothing to disclose D. Durany Lara: Nothing to disclose B. Bové: Nothing to disclose C. Martinez-Alvez: Nothing to disclose I. Tapiolas: Nothing to disclose

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