Sigmoid kolon lümeni içinde yerleşimli endometriozis/ ekstragenital endometriozis

Endometriozis, endometrial gland ve stromanin uterin kavite disinda gorulmesine denir. Dogurganlik cagindaki kadinlarda sik gorulen bir hastalik olmakla birlikte, intestinal endometriozis oldukca nadir gorulur ve onemli klinik sorunlara yol acabilir. Bu makalede seyrek olarak rastlanan, sigmoid kolon lumeninde iki endometriozis vakasi takdim edilmektedir. Birinci vakamiz; yaklasik 6 aydir mevcut rektal kanama sikayeti ile basvuran 45 yasinda ka- din hastadir. Yapilan kolonoskopisinde; sigmoid kolonda 3-4 cm capinda malign gorunumlu polipoid lezyon tespit edildi. Polip kolonoskopik eksizyon icin uygun olmadigindan ve hastanin kanama sikayetleri devam ettiginden hastaya laparoskopik anterior rezeksiyon yapildi. Patoloji sonucu, ekstragenital endometriozis olarak raporlandi. Ikinci vakamiz; 36 yasinda kadin hastadir. Yaklasik 3 aydir suren karin agrisi ve rektal kanama sikayetiyle acil servise basvurdu. Yapilan tetkikler sonrasinda hastada sigmoid kolon duzeyinde divertikulite rastlandi. Medikal tedavi ile semptomlari geriledi fakat sikayetleri erken donemde sik tekrarladigindan, elektif sartlarda laparoskopik anterior rezeksiyon yapilmasina karar verildi. Patoloji sonucu, divertikulozis koli ve intraluminal endometriozis olarak rapor- landi. Sonuc olarak konstipasyon, gastrointestinal kanama, bulanti, kusma, kramp tarzi karin agrisi, diyare ve pelvik agri ile basvuran dogurganlik cagindaki kadin hastalarda ayirici tanida akla intestinal endometriozis de gelmelidir. Bu tip hastalarda etkilenmis bagirsak segmentinin rezeksiyonu ve anastomoz en iyi tedavi yontemi olarak kabul gormektedir. Anahtar kelimeler: Ekstragenital endometriozis, laparoskopi, anterior rezeksiyon, sigmoid kolon Endometriosis is the presence of endometrial glands and stroma outside the uterine cavity. Although it is common in women in the reproductive age, intestinal endometriosis is extremely rare and may lead to serious clinical prob- lems. In this article, we present two rare cases of endometriosis localized in the sigmoid colon lumen. The first case is a 45 year-old female complaining of rectal bleeding for 6 months. A polypoid lesion with suspicion of malignancy, 3-4 cm in size was identified at colonoscopy. Laparoscopic anterior resection was performed since it was not suitable for colonoscopic polypectomy. The pathology examination revealed extragenital endometriosis. The second case is a 36 year-old female admitted for lower abdominal pain and rectal bleeding for the last 3 months. She was diagnosed with sigmoid diverticulitis. The patient's symptoms regressed with medical treatment, but due to early and multiple recurrent episodes it was decided to perform an elective laparoscopic anterior resection. The pathology report stated diverticulosis coli and intraluminal endometriosis. Intestinal endometriosis should be considered as part of the differential diagnosis in female patients of the reproductive age who present with constipation, gastrointestinal bleeding, nausea, vomiting, cramp-like abdominal pain, diarrhea and pelvic pain. In these patients, resection and anastomosis of the effected bowel segment is accepted as the choice of treatment. ABSTRACT Ulus Cerrahi Derg 2015; 31: 250-2