Catamenial rectal bleeding as a manifestation of rectosigmoid endometriosis in a young woman: a case report and literature review

Gustavo Adolfo Hernández Valdez, Juan C. Delgadillo Tortajada, Saray A. Aguayo Huerta, Anahi Herrera Ruelas, Natanael Barrera Plascencia, Jesús A. Hernández Ramos, José G. Mendoza Molina
In: International Journal of Research in Medical Sciences · 2026 · vol. 14(11) , pp. 5411–5414 · doi:10.18203/2320-6012.ijrms20264207 · W7224996194
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A 21-year-old woman with catamenial rectal bleeding was diagnosed with rectosigmoid endometriosis via colonoscopic biopsy, demonstrating that mucosal or submucosal involvement allows for definitive diagnosis despite normal initial evaluations.

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This case report describes a 21-year-old woman presenting with a three-year history of recurrent catamenial rectal bleeding despite normal initial gynecologic evaluations and a prior negative colonoscopy. A subsequent colonoscopy revealed edema and loss of vascular pattern in the rectum and sigmoid colon, where biopsies identified glandular structures consistent with endometriosis extending toward the submucosa. The authors conclude that bowel endometriosis should be considered in reproductive-aged women with cyclic rectal bleeding, as colonoscopic biopsy can establish the diagnosis when mucosal or submucosal involvement is present. This paper is centrally about endometriosis — specifically the diagnosis of deep infiltrating bowel endometriosis manifesting as catamenial rectal bleeding.

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Abstract

Bowel endometriosis is a manifestation of deep endometriosis that most commonly involves the rectum and sigmoid colon. Diagnosis can be challenging because disease involvement usually predominates in the outer layers of the bowel wall, while endoscopic findings may be normal or nonspecific. We report the case of a 21-year-old woman with a three-year history of recurrent catamenial rectal bleeding, an unrevealing initial gynecologic evaluation, and a previous colonoscopy without relevant abnormalities. Because bleeding persisted, repeat colonoscopy was performed and showed edema and loss of the vascular pattern in the rectum and sigmoid colon. Rectosigmoid biopsies demonstrated glandular structures extending toward the submucosa that were morphologically compatible with endometriosis. Clinicopathologic correlation established the diagnosis of bowel endometriosis. This case highlights the importance of considering rectosigmoid endometriosis in reproductive-aged women with cyclic rectal bleeding, even after a previous negative endoscopic evaluation, and illustrates that colonoscopic biopsy may establish the diagnosis when mucosal or submucosal involvement is present.
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Catamenial rectal bleeding as a manifestation of rectosigmoid endometriosis in a young woman: a case report and literature review DOI: https://doi.org/10.18203/2320-6012.ijrms20264207Keywords: Bowel endometriosis, Hematochezia, Rectosigmoid endometriosis, Catamenial rectal bleeding, ColonoscopyAbstract Bowel endometriosis is a manifestation of deep endometriosis that most commonly involves the rectum and sigmoid colon. Diagnosis can be challenging because disease involvement usually predominates in the outer layers of the bowel wall, while endoscopic findings may be normal or nonspecific. We report the case of a 21-year-old woman with a three-year history of recurrent catamenial rectal bleeding, an unrevealing initial gynecologic evaluation, and a previous colonoscopy without relevant abnormalities. Because bleeding persisted, repeat colonoscopy was performed and showed edema and loss of the vascular pattern in the rectum and sigmoid colon. Rectosigmoid biopsies demonstrated glandular structures extending toward the submucosa that were morphologically compatible with endometriosis. Clinicopathologic correlation established the diagnosis of bowel endometriosis. This case highlights the importance of considering rectosigmoid endometriosis in reproductive-aged women with cyclic rectal bleeding, even after a previous negative endoscopic evaluation, and illustrates that colonoscopic biopsy may establish the diagnosis when mucosal or submucosal involvement is present. Metrics References WHO. Endometriosis, 2026. Available at: https://www.who.int/newsroom/factsheets/detail/endometriosis. Accessed on 11 September 2026. Becker CM, Bokor A, Heikinheimo O, Horne A, Jansen F, Kiesel L, et al. ESHRE guideline: endometriosis. Hum Reprod Open. 2022;2022(2):hoac009. Koninckx PR, Ussia A, Adamyan L, Wattiez A, Donnez J. Deep endometriosis: definition, diagnosis, and treatment. Fertil Steril. 2012;98(3):564-71. DOI: https://doi.org/10.1016/j.fertnstert.2012.07.1061 Remorgida V, Ragni N, Ferrero S, Anserini P, Torelli P, Fulcheri E. The involvement of the muscularis propria and the plexuses of the large bowel in deep infiltrating endometriosis. Hum Reprod. 2005,20:2303-7. DOI: https://doi.org/10.1093/humrep/deh568 Habib N, Centini G, Lazzeri L, Amoruso N, El Khoury L, et al. Bowel Endometriosis: Current Perspectives on Diagnosis and Treatment. Int J Womens Health. 2020;12:35-47. DOI: https://doi.org/10.2147/IJWH.S190326 Fauconnier A, Chapron C, Dubuisson JB, Vieira M, Dousset B, Bréart G. Relation between pain symptoms and the anatomic location of deep infiltrating endometriosis. Fertil Steril. 2002;78(4):719-26. Fauconnier A, Chapron C, Dubuisson JB, Vieira M, Dousset B, Bréart G. Relation between pain symptoms and the anatomic location of deep infiltrating endometriosis. Fertil Steril. 2002;78(4):719-26. DOI: https://doi.org/10.1016/S0015-0282(02)03331-9 Chiaffarino F, Cipriani S, Ricci E, Mauri PA, Esposito G, Barretta M, et al. Endometriosis and irritable bowel syndrome: a systematic review and meta-analysis. Arch Gynecol Obstet. 2021;303(1):17-25. DOI: https://doi.org/10.1007/s00404-020-05797-8 Keith JJ, Hernandez LO, Maruoka Nishi LY, Jethwa TP, Lewis JT, Pujalte GGA. Catamenial rectal bleeding due to invasive endometriosis: a case report. J Med Case Rep. 2020;14(1):61. DOI: https://doi.org/10.1186/s13256-020-02386-w Subbaraj L, Bowman CJ, Singh A. A masked diagnosis: sigmoid endometriosis. ACG Case Rep J. 2021,8:00557. DOI: https://doi.org/10.14309/crj.0000000000000557 Bong JW, Yu CS, Lee JL, Kim CW, Yoon YS, Park IJ, et al. Intestinal endometriosis: Diagnostic ambiguities and surgical outcomes. World J Clin Cases. 2019 Feb 26;7(4):441-51. DOI: https://doi.org/10.12998/wjcc.v7.i4.441 Bazot M, Kermarrec E, Bendifallah S, Daraï E. MRI of intestinal endometriosis. Best Pract Res Clin Obstet Gynaecol. 2021;71:51-63. DOI: https://doi.org/10.1016/j.bpobgyn.2020.05.013 Dave HB, Chamié LP, Young SW, Sakala MD, VanBuren WM, Jha P, et al. Bowel Endometriosis: Systematic Approach to Diagnosis with US and MRI. Radiographics. 2025;45(4):e240102. DOI: https://doi.org/10.1148/rg.240102 Ferrero S, Stabilini C, Barra F, Clarizia R, Roviglione G, Ceccaroni M. Bowel resection for intestinal endometriosis. Best Pract Res Clin Obstet Gynaecol. 2021;71:114-28. DOI: https://doi.org/10.1016/j.bpobgyn.2020.05.008 Abrão MS, Borrelli GM, Clarizia R, Kho RM, Ceccaroni M. Strategies for Management of Colorectal Endometriosis. Semin Reprod Med. 2017;35(1):65-71. DOI: https://doi.org/10.1055/s-0036-1597307 Nnoaham KE, Hummelshoj L, Webster P, d'Hooghe T, de Cicco Nardone F, de Cicco Nardone C, et al. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril. 2011;96(2):366-73. DOI: https://doi.org/10.1016/j.fertnstert.2011.05.090 Hudelist G, Fritzer N, Thomas A, Niehues C, Oppelt P, Haas D, Tammaa A, Salzer H. Diagnostic delay for endometriosis in Austria and Germany: causes and possible consequences. Hum Reprod. 2012;27(12):3412-6. DOI: https://doi.org/10.1093/humrep/des316 Downloads Published How to Cite Issue Section License Copyright (c) 2026 Gustavo A. Hernandez Valdez, Juan C. Delgadillo Tortajada, Saray A. Aguayo Huerta, Anahi Herrera Ruelas, Natanael Barrera Plascencia, Jesus A. Hernandez Ramos, José G. Mendoza Molina This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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