Intestinal endometriosis: A rare clinical image of sigmoid presentation

Mert Doruk Bal
In: Journal of Clinical Images and Medical Case Reports · 2023 · vol. 4(11) · doi:10.52768/2766-7820/2696 · W4396784337
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This case report describes a 47-year-old female with a sigmoid colon mass diagnosed as endometriosis, who was successfully treated with surgical resection.

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This clinical image paper describes a 47-year-old woman with a history of umbilical endometriosis and iron deficiency anemia who presented with one year of abdominal pain, rectal pain, and menstruation-associated hematochezia. Contrast MRI showed rectal wall thickening and bilateral ovarian “chocolate cysts,” and colonoscopy identified an actively bleeding sigmoid mass partially narrowing the lumen; biopsy confirmed histologic features consistent with endometriosis, with malignancy raised as a differential pre-procedure. The patient underwent sigmoid colon resection plus hysterectomy and bilateral oophorectomy, and her symptoms ceased on postoperative follow-up, with the main limitation being its single-patient case-report nature. This paper is centrally about endometriosis — an intestinal/sigmoid presentation of endometriosis confirmed by biopsy and imaging.

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Abstract

A 47-year-old female patient with a history of umbilical endometriosis and iron deficiency anemia presented to the gastroenterology department with a year-long complaint of abdominal pain, rectal pain, and hematochezia during menstruation. The physical examination and the results of laboratory studies of the patient were unremarkable. A contrast MRI of the abdomen revealed pathological thickening of 1.5 cm in the middle segment of the rectum and chocolate cysts on both ovaries, and the patient was referred for colonoscopic evaluation with suspicion of infiltrative endometriosis or colon neoplasm. An upper endoscopy and colonoscopy were performed. An actively bleeding mass in sigmoid colon, partially restricting the lumen but allowing for the passage of the video colonoscope, was observed (Figure 1A,1B: Sigmoid lesion). Biopsy specimens from the sigmoidal mass showed features consistent with endometriosis. A diagnosis of endometriosis was made. The patient underwent surgical intervention by sigmoid colon resection, hysterectomy, and bilateral oophorectomy. The complaints ceased on postoperative follow-up.
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Open Access, Volume 4 Intestinal endometriosis: A rare clinical image of sigmoid presentation Clinical Image www.jcimcr.org Journal of Clinical Images and Medical Case Reports Received: Oct 12, 2023 Accepted: Nov 10, 2023 Published: Nov 17, 2023 Archived: www.jcimcr.org Copyright: © Bal MD (2023). DOI: www.doi.org/10.52768/2766-7820/2696 *Corresponding Author: Mert Doruk Bal Department of Internal Medicine, Acibadem Mehm- et Ali Aydinlar University School of Medicine, Istan - bul, Turkey. Email: [email protected] ISSN 2766-7820 Clinical image description A 47-year-old female patient with a history of umbilical en - dometriosis and iron deficiency anemia presented to the gastro- enterology department with a year-long complaint of abdomi - nal pain, rectal pain, and hematochezia during menstruation. The physical examination and the results of laboratory studies of the patient were unremarkable. A contrast MRI of the abdo- men revealed pathological thickening of 1.5 cm in the middle segment of the rectum and chocolate cysts on both ovaries, and the patient was referred for colonoscopic evaluation with sus - picion of infiltrative endometriosis or colon neoplasm. An up - per endoscopy and colonoscopy were performed. An actively bleeding mass in sigmoid colon, partially restricting the lumen but allowing for the passage of the video colonoscope, was ob- served (Figure 1A,1B: Sigmoid lesion). Biopsy specimens from the sigmoidal mass showed features consistent with endome - triosis. A diagnosis of endometriosis was made. The patient un- derwent surgical intervention by sigmoid colon resection, hys - terectomy, and bilateral oophorectomy. The complaints ceased on postoperative follow-up. Safak Kiziltas; Mert Doruk Bal* Department of Internal Medicine, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey. Figure 1: Sigmoid lesion. Citation: Kiziltas S, Bal MD. Intestinal endometriosis: A rare clinical image of sigmoid presentation. J Clin Images Med Case Rep. 2023; 4(11): 2696.

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