A case of rectal bleeding caused by digestive endometriosis resembling colon cancer

Bulent Yilmaz, Bülent Yılmaz, Yilmaz B, Selma Cukur, Selma Çukur, Cukur S, Rula Sahin, Rula Şahin, Sahin R
Endoscopy · 2014 · vol. 46(S 01) , pp. E357–E358 · doi:10.1055/s-0034-1377378 · PMID:25198922 · W2323764131
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A 42-year-old woman with rectal bleeding presented with sigmoid colon thickening and narrowing resembling colon cancer, but biopsies were nondiagnostic.

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This case report describes a 42-year-old woman presenting with rectal bleeding and iron deficiency anemia, whose colonoscopy revealed polypoid mucosal thickening in the sigmoid colon that initially mimicked colon cancer. Despite nondiagnostic endoscopic biopsies, surgical resection confirmed the diagnosis of polypoid endometriosis penetrating the bowel wall and adhering to the posterior uterine wall, highlighting the diagnostic challenge of this rare variant. The authors note that while endoscopic appearance is not definitive and biopsies are often insufficient, endoscopic ultrasound and surgery remain critical for accurate identification and management of intestinal lesions. This paper is centrally about endometriosis — specifically deep infiltrating digestive endometriosis involving the sigmoid colon.

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Abstract

A 42-year-old unmarried, nulliparous woman presented at our hospital with rectal bleeding. The patient had had iron deficiency anemia in the past. She had normal, regular menses with mild dysmenorrhea and had not taken hormonal drugs. Her physical examination was unremarkable. Colonoscopy revealed widespread polypoid mucosal thickening and luminal narrowing, along with erythema and edema, in the sigmoid colon. It was not possible to pass the endoscope beyond the lesion ([Fig. 1]). Multiple endoscopic biopsies were taken, but histopathologic examination was nondiagnostic. An abdominal computed tomography (CT) scan revealed eccentric thickening of the wall of the sigmoid colon ([Fig. 2]).
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References

1 Schwartz JL , Schwartz LB . Extrapelvic endo- metriosis. In: Diamond MP, Osteen KG, eds. Endometrium and Endometriosis. Maden, Massachusetts: Blackwell Science; 1997: 247 – 254 2 Pishvaian AC , Ahlawat SK , Garvin D et al. Role of EUS and EUS-guided FNA in the diag- nosis of symptomatic rectosigmoid endo- metriosis. Gastrointest Endosc 2006; 63: 331 – 335 3 Parker RL , Dadmanesh F , Young RH et al. Polypoid endometriosis: a clinicopathologic analysis of 24 cases and a review of the lit- erature. Am J Surg Pathol 2004; 28: 285 – 297 4 Bhutani MS . Recent developments in the role of endoscopic ultrasonography in dis- eases of the colon and rectum. Curr Opin Gastroenterol 2007; 23: 67 – 73 5 Buchweitz O, Poel T, Diedrich K et al. The di- agnostic dilemma of minimal and mild en- dometriosis under routine conditions. J Am Assoc Gynecol Laparosc 2003; 10: 85 – 89

Bibliography

DOI http://dx.doi.org/ 10.1055/s-0034-1377378 Endoscopy 2014; 46: E357 –E358 © Georg Thieme Verlag KG Stuttgart · New York ISSN 0013-726X Corresponding author Bulent Yilmaz, MD Bolu Izzet Baysal State Hospital Department of Gastroenterology PK: 14280 Bolu Turkey Fax: +90-374-2534615 [email protected] Yilmaz Bulent et al. Digestive endometriosis resembling colon cancer … Endoscopy 2014; 46: E357 –E358 Cases and Techniques Library (CTL)E358 This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.

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Condition tags

endometriosisdysmenorrhea

MeSH descriptors

Colonic Neoplasms Endometriosis Gastrointestinal Hemorrhage Sigmoid Diseases Adult Colonic Neoplasms Colonoscopy Diagnosis, Differential Endometriosis Endometriosis Female Gastrointestinal Hemorrhage Humans Rectum Sigmoid Diseases Sigmoid Diseases

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