COLONIC ENDOMETRIOSIS

A 40 year old female with a history of supracervical hysterectomy for fibroids, was seen at our clinic complaining of sharp intermittent lower abdominal pain, constipation, intermittent hematochezia while bearing down as well as a decreasing caliber of her bowel movements for one year. She denied weight loss, nausea, and vomiting, family history- non contributory. Vitals and physical findings were negative except for mild rectal discomfort. Her laboratory values were normal. CTABD revealed a 2cm well defined soft tissue mass of the sigmoid colon indenting the lumen. Colonoscopy revealed a submucosal lesion in the sigmoid colon occupying 2/3s of the luminal circumference 20cm from the anal verge and hemorrhoids. Multiple biopsies were read as normal colonic mucosa. Patient was referred to surgery, a wedge resection was performed. Pathology of the specimen was read as endometrial tissue in intestinal wall. Discussion: Endometriosis is a common disorder among females between 20 to 45 years old. 3–37% of those woman will have gastrointestinal involvement. The most common location is in the rectosigmoid region followed by the appendix and ileum respectively. Symptoms range and depend upon location and penetration of the endometrial implants. Serosal involvement may be asymptomatic or may cause localized abdominal pain, back pain while penetration into the bowel wall may lead to constipation, diarrhea, partial obstruction. Mucosal invasion which is uncommon, may lead to hematochezia which is infrequently cyclical or colonic fibrosis and ischemia. Other presentations include appendicitis, volvulus and intussusception. Diagnosis is usually difficult since the symptoms are vague and may resemble many gastrointestinal disorders including malignancy, Inflammatory Bowel Disease, Irritable Bowel Syndrome. In general, endometriosis is detected intra or post operatively. Colonoscopy, CAT scans, Barium enemas, may assist in the diagnosis however laparoscopy/laparotomy usually make for definite diagnosis. Treatment of endometriosis involving the intestinal tract generally involves surgery. Preoperative GH-RH analogs hormonal treatment has been used as well. Conclusion: Endometriosis is an uncommon cause of gastrointestinal complaints; however it should be included in the differential diagnosis of gastrointestinal symtoms in premenopausal woman.