A CASE OF RECTAL ENDMETRIOSIS FOLLOWED UP FOR A YEAR

A 47-year-old woman was admitted to the hospital because of constipation at menses. Barium enema study and a colonoscopy revealed a whole-circumference stenosis in the rectum covered with normal mucosa. CT and magnetic resonance imaging (MRI) revealed a restiform structure between the uterus and rectum, and also revealed a right ovarian cyst. In the light of these findings, we diagnosed the case as rectal endometriosis. In spite of the hormone therapy for a year. no remission in constipation at menses was attained. What is worse, side effect of the hormone therapy occurred. Therefore, a partial rectal resection and a total hysterectomy were performed. The operative findings showed a firm adhesion between the uterus and rectum and a chocolate cyst at the right ovarium. Histopathologically, endometrial cells with fibrotic change were seen in the submucosal layer of the rectum. Endometriosis is characterized by ectopic proliferation of endometrial cells. Intestinal endometriosis is relatively rare disease and only 84 cases have been reported in the Japanese literature up to now. It is often difficult to make definite diagnosis preoperatively and careful attitude is essential to indicate operation and to select therapeutic tactics.