S2591 Resolution of IBS Symptoms After Resection on Delayed Diagnosis of Sigmoid Endometriosis

Introduction: Extrauterine endometriosis is a rare condition with varied presentation clinically and also on both imaging and colonoscopy. Here we describe a case of sigmoid endometriosis that initially presented as a prolonged, self-limited IBS symptoms and periodic colonic strictures on imaging, with resolution of symptoms following bowel resection which confirmed endometriosis. Case Description/Methods: A 42-year-old woman who was referred to GI for cyclical constipation and diarrhea, intermittent hematochezia, and symptoms of self-limited bowel obstruction, worsening but unclear if this was related to her menstrual cycle due to total hysterectomy at a young age. Patient reports that these symptoms have been intermittent for almost 10 years and was treated as IBS for a while. Repeated colonoscopies demonstrated no evidence of hemorrhoids to explain lower GI bleeding but showed evidence of sigmoid stricture. However, degree of stricture varied from minimal asymptomatic colon wall involvement to 90% luminal stenosis without obstruction on at least 5 colonoscopies and numerous CT imaging studies over many years. The patient was referred for surgical intervention after failed from repeated endoscopic dilations. She subsequently went for robotic partial colectomy with anastomosis with complete resolution of all GI symptoms. Pathology analysis of surgical specimens confirmed GI endometriosis, displaying colonic mucosa with extensive endometriosis involving submucosal and subserosal tissue (Figure 1). Discussion: Intestinal endometriosis is a rare and uncommon etiology of a colonic mass and gastrointestinal bleeding. Diagnosis can be difficult as its presentation and symptoms can be varied on both colonoscopy and CT imaging. Here, we demonstrate sigmoid endometriosis presenting with partial bowel obstruction with periodic GI bleeding with waxing and waning symptoms. Her symptoms resolved following surgical resection of the affected colon. It was difficult to match the patients’ symptoms with her menstrual cycle given her early hysterectomy. Colonic endometriosis must remain in the differential for self-limited bowel obstruction and periodic GI bleeding in this specific population.Figure 1.: Colonoscopy and CT findings with pathology following resection.