Rectal endometriosis: a case report

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This case report details a patient initially suspected of malignancy who was ultimately diagnosed with rectal endometriosis after surgery revealed adhesions and histopathology confirmed the condition.

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This paper reports a case of a 45-year-old woman admitted with pelvic pain, constipation, and dysmenorrhea, where CT and ultrasound also suggested cholelithiasis, benign liver nodular hyperplasia, and uterine fibromyoma. During laparotomy, firm adhesions were found between the posterior uterus and rectum, and an incisional biopsy initially revealed undifferentiated adenocarcinoma, prompting total uterine resection with en bloc resection of adherent rectal and posterior vaginal wall tissue. Final histopathology showed rectal endometriosis along with uterine fibromyoma and liver nodular hyperplasia, with no malignancy, and the patient remained healthy at 5-year follow up. This is a single case report and therefore does not provide generalizable diagnostic performance; it concludes that rectal endometriosis is an uncommon localization with non-specific symptoms that can be difficult to diagnose preoperatively and should be considered in the differential diagnosis. This paper is centrally about endometriosis — it is a case report specifically focused on rectal endometriosis.

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Abstract

We present the case of a 45-year-old female patient who was admitted with a history of pelvic pain, constipation, and dysmenorrhea. CT scan and u/s images revealed cholelithiasis, benign nodular hyperplasia of segment IV of the liver and uterine fibromyoma. During laparotomy, firm adhesions between the posterior wall of the uterus and the rectum were found and the incisional biopsy reveals an undifferentiated adenocarcinoma. Then, total resection of the uterus was performed with en block resection of the adherent part of the rectum and part of the posterior wall of the vagina. The final histopathological report showed the presence of uterine fibromyoma, nodular hyperplasia of the liver and rectal endometriosis without any sign of malignancy. The patient after 5 years of follow up remains healthy. Rectal endometriosis represents an uncommon localization of pelvic endometriosis where the symptoms and clinical findings are non-specific making the definitive preoperative diagnosis difficult. Endometriosis should be included in the differential diagnosis of chronic pelvic pain in combination with defecation disorders in female patients of reproductive age.
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Abstract

We present the case of a 45-year-old female patient who was admitted with a history of pelvic pain, constipation, and dysmenorrhea. CT scan and u/s images revealed cholelithiasis, benign nodular hyperplasia of segment IV of the liver and uterine fibromyoma. During laparotomy, firm adhesions between the posterior wall of the uterus and the rectum were found and the incisional biopsy reveals an undifferentiated adenocarcinoma. Then, total resection of the uterus was performed with en block resection of the adherent part of the rectum and part of the posterior wall of the vagina. The final histopathological report showed the presence of uterine fibromyoma, nodular hyperplasia of the liver and rectal endometriosis without any sign of malignancy. The patient after 5 years of follow up remains healthy. Rectal endometriosis represents an uncommon localization of pelvic endometriosis where the symptoms and clinical findings are non-specific making the definitive preoperative diagnosis difficult. Endometriosis should be included in the differential diagnosis of chronic pelvic pain in combination with defecation disorders in female patients of reproductive age. Similar content being viewed by others

References

Anaf V, Sperduto N, Simon P, Noel JC, El Nakadi I (2000) Laparoscopically assisted segmental sigmoid resection (LASSR) for sigmoid endometriosis. Gynaecol Endosc 9:95–101 Beltran MA, Tapia QT, Araos HF et al (2006) Ileal endometriosis as a cause of intestinal obstruction. Report of two cases. Rev Med Chil 134:485–490 Camara O, Hermann J, Egbe A et al (2009) Treatment of endometriosis of uterosacral ligament and rectum through the vagina: description of a modified technique. Hum Reprod 24:1407–1413 Rock J, Markham SM (1992) Pathogenesis of endometriosis. Lancet 340:1264–1267 Yildirim S, Nursal T, Tarim A et al (2005) Colonic obstruction due to rectal endometriosis: report of a case. Turk J Gastrenterol 16(1):48–51 Ridha JR, Cassaro S (2003) Acute small bowel obstruction secondary to ileal endometriosis: report of a case. Surg Today 33:944–947 Uchiyama S, Haruyama Y, Asada T et al (2010) Rectal endometriosis masquerading as dissemination in a patient with rectal cancer. Surg Today 40:672–675 Jones KD, Owen E, Berresford A et al (2002) Endometrial adenocarcinoma arising from endometriosis of the rectosigmoid colon. Gynecol Oncol 86:220–222 Cameron IC, Rogers S, Collins MC et al (1995) Intestinal endometriosis: presentation, investigation, and surgical management. Int J Colorectal Dis 10:83–86 Chen KT (2002) Endometrioid adenocarcinoma arising from colonic endometriosis mimicking primary colonic carcinoma. Int J Gynecol Pathol 21:285–288 Conflict of interest The authors certify that there is no actual or potential conflict of interest in relation to this article. Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Papadopoulos, V.N., Panagiotou, D., Panidis, S. et al. Rectal endometriosis: a case report. Tech Coloproctol 15 (Suppl 1), 105–106 (2011). https://doi.org/10.1007/s10151-011-0743-z Published: Issue date: DOI: https://doi.org/10.1007/s10151-011-0743-z

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Condition tags

dysmenorrheaendometriosischronic_pelvic_pain

MeSH descriptors

Adenocarcinoma Endometriosis Leiomyoma Rectal Diseases Uterine Neoplasms Adenocarcinoma Chronic Pain Chronic Pain Constipation Constipation Diagnosis, Differential Dysmenorrhea Dysmenorrhea Endometriosis Endometriosis Endometriosis Female Humans Leiomyoma Leiomyoma

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