P065 Inflammatory Bowel Disease or Bowel Endometriosis? Two Cases of Large Bowel Obstruction

CASE: Endometriosis, endometrial glands and stroma outside of the uterus, may occur in “extragenital” locations and can present with inflammatory symptoms and/or bowel obstruction similar to inflammatory bowel disease (IBD). We report 2 cases of reproductive-aged women with inflammatory and/or obstructive symptoms secondary to presumed IBD who were found to have endometriosis on surgical pathology. The first patient presented with weight loss, generalized abdominal nausea, and vomiting, and she was found to have an inflammatory cecal mass during endoscopic evaluation for IBD. At operation, an inverted appendix was identified and removed. Surgical pathology revealed appendiceal endometriosis. The second patient was diagnosed with fibrostenotic and inflammatory Crohn's disease of the sigmoid colon. Despite treatment with biologics, she suffered obstructive symptoms from a sigmoid stricture that could not be traversed endoscopically. She was taken to the operating room for sigmoid colectomy. Final pathology revealed endometriosis. In reproductive age women with gastrointestinal manifestations that are unusual for IBD or that do not respond predictably to medical therapy, endometriosis should be considered in the differential diagnosis.