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.