Solitary intraluminal colonic endometrioma presenting with colonic obstruction: a case report

- Page Path - HOME > Kosin Med J > Volume 41(3); 2026 > Article - Case report Solitary intraluminal colonic endometrioma presenting with colonic obstruction: a case report - Seung Jun Lee1, Jung Wook Suh2 - Kosin Medical Journal 2026;41(3):256-259. DOI: https://doi.org/10.7180/kmj.26.101 Published online: July 13, 2026 1Department of Obstetrics and Gynecology, Dankook University Hospital, Cheonan, Korea 2Department of Surgery, Dankook University Hospital, Cheonan, Korea - Corresponding Author: Jung Wook Suh, MD Department of Surgery, Dankook University Hospital, 119 Dandae-ro, Dongnam-gu, Cheonan 31116, Korea Tel: +82-41-550-3891, Fax: +82-41-565-6167, E-mail: [email protected] • Received: January 14, 2026 • Revised: February 27, 2026 • Accepted: April 19, 2026 © 2026 Kosin University College of Medicine. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. - 525 Views - 4 Download - Colonic endometrioma is an uncommon clinical manifestation that may occur in women of reproductive age. It is frequently misdiagnosed as intestinal malignancy, irritable bowel syndrome, or intussusception. Because its signs and symptoms are nonspecific, intestinal endometriosis remains difficult to diagnose preoperatively. Hepatocyte growth factor, fibroblast growth factor, epidermal growth factor, vascular endothelial growth factor, and interleukin (IL)-1, IL-6, and IL-8 have been regarded as potential markers of endometriosis. More recently, microRNAs have also been proposed as viable diagnostic indicators. However, histological confirmation remains essential and may require tissue acquisition through endoscopic procedures, such as deep biopsy, digging biopsy, or unroofing biopsy, or during diagnostic laparoscopy. We report the case of a 40-year-old female patient with a solitary intraluminal colonic endometrioma who presented with colonic obstruction. She was referred from a local secondary hospital to our emergency department with constipation and severe abdominal pain that had persisted for 10 days. Computed tomography and sigmoidoscopy were performed for preoperative evaluation, and a colonic stent was placed under fluoroscopic guidance to relieve the obstructive symptoms. Subsequently, laparoscopic surgery was performed. The lesion was completely excised, with no residual tissue remaining. The patient is currently receiving hormone therapy to prevent recurrence. - Endometriosis is characterized by the presence of endometrium-like epithelium and/or stroma outside the endometrium and myometrium, usually with an associated inflammatory process [1]. Its exact prevalence is unknown, but estimates range from 2% to 10% in the general female population and up to 50% in women with infertility [2-4]. Case reports in surgical and gynecological literature have demonstrated the presence of extrapelvic endometriosis in nearly all organ systems and tissues, including the central nervous system, lungs, pleura, heart, diaphragm, gallbladder, liver, small intestine, appendix, colon, rectum, kidneys, bladder, and ureters. The umbilicus, abdominal wall incision sites, episiotomy scars, biceps muscle, bone, and peripheral nerves were also described in the literature [5]. Among women who have undergone laparoscopies or laparotomies for endometriosis-related pelvic pain or infertility, 5% to 15% have intestinal involvement, and the most common parts of the intestines are the sigmoid and rectum [6]. But, owing to its nonspecific signs and symptoms, intestinal endometriosis is indeed challenging to diagnose preoperatively. Hepatocyte growth factor, fibroblast growth factor, epidermal growth factor, vascular endothelial growth factor, and interleukin (IL)-1, IL-6, and IL-8 are regarded as potential markers of endometriosis, as the formation of ectopic implants is associated with invasion, proliferation, and angiogenesis [7]. In other literature, microRNAs may serve as viable indicators for the early detection and control of endometriosis development [8]. However, confirming the histological diagnosis of lesions acquired by endoscopic procedures, such as deep biopsy, digging biopsy, or unroofing biopsy during diagnostic laparoscopy, is essential. Herein, we report the case of a 40-year-old female patient who presented with colonic obstruction secondary to sigmoid colonic endometrioma. This case is clinically significant because the colonic obstruction was extremely severe and intestinal stent insertion was performed to relieve the symptoms preoperatively. - Ethical statements: This study was exempted from review by the Institutional Review Board (IRB) of Dankook University Hospital (IRB No. DKUH 2025-12-009). Written informed consent was obtained from the patient for publication of this case report and accompanying images. - A 40-year-old female patient was referred from a local secondary hospital to our hospital’s emergency room with constipation and severe abdominal pain lasting 10 days. A computed tomography (CT) scan and sigmoidoscopy were performed at the local secondary hospital. The CT scan confirmed colonic distension and abrupt narrowing of the sigmoid colon, accompanied by an approximately 4-cm enhancing lesion and minor ascites. A soft tissue density was observed in the rectouterine pouch (Fig. 1). The initial diagnosis based on the CT scan was sigmoid colon cancer accompanied by colonic obstruction. They performed a sigmoidoscopy and identified an ulceroinfiltrative tumor with an irregular surface, swelling, and hemorrhaging that led to a luminal narrowing of the sigmoid colon (Fig. 2). Subsequently, the patient was referred to the emergency department. Initially, we suspected an obstruction due to the sigmoid colon cancer, which impeded stool passage. Thus, we performed a stent placement to expand the intestinal lumen at the location of the tumor and confirmed the proper positioning via fluoroscopy (Fig. 3). We performed an additional colonoscopic biopsy for confirmation, and the results indicated chronic inflammation accompanied by edema and abundant mucus. Based on our strong suspicion of colon cancer, we performed laparoscopic low anterior resection. No notable abnormalities were observed in the abdominal cavity, other than minor adhesions around the uterus. - The patient recovered fully and was discharged on postoperative day 13. The final pathology results confirmed the diagnosis of intestinal endometriosis with no residual endometriosis or malignancies identified at the resection margins. Hormone therapy was initiated 1 month after the operation to prevent recurrence. - Endometriosis is a persistent inflammatory disease characterized by the development of endometrial glands and stroma outside the uterine cavity [9]. Endometriotic lesions may occur in any tissue or organ, with intestinal involvement reported in 3%–37% of all endometriosis cases [10]. The most common symptoms of intestinal endometriosis include intestinal bleeding, bowel distension, painful defecation, abdominal pain, constipation, and diarrhea, all of which worsen during menstruation. In the present case, the patient experienced discomfort, painful bowel, and constipation. These symptoms corresponded to those described in the literature on intestinal endometriosis. However, the nonspecific nature of these symptoms makes the clinical diagnosis particularly challenging, even with a comprehensive evaluation including imaging modalities. Ultrasonography is the primary imaging technique for evaluating endometriosis due to its accessibility, minimal invasiveness, and cost-effectiveness and magnetic resonance imaging is widely recognized as an essential tool for diagnosis and presurgical planning [11]. Nevertheless, these imaging modalities are sometimes insufficient for the precise identification of intestinal endometriosis. In cases where symptoms indicative of intestinal obstruction arise in women of reproductive age, it is essential to thoroughly evaluate their menstrual cycles and obstetric history prior to conducting laparoscopy, which remains the gold standard diagnostic procedure for endometriosis. In this case, we failed to diagnose intestinal endometriosis preoperatively. Nevertheless, with a retrospective review, we recognized that we had the opportunity to detect it earlier during sigmoidoscopy, as we did not perceive it as a malignant lesion. - In conclusion, intestinal endometriosis is a condition that affects women of reproductive age and is characterized by clinical manifestations, such as intestinal bleeding, bowel distension, indigestion, abdominal pain, constipation, and diarrhea, which are exacerbated during the menstrual cycle. Establishing a diagnosis prior to histopathological diagnosis of lesions obtained via diagnostic laparoscopy is challenging. Following the diagnosis, the patients' requirements for reproduction or family planning must be reassessed. Hormone therapy is recommended to prevent recurrence. - Conflicts of interest No potential conflict of interest relevant to this article was reported. - Funding None. - Author contributions Conceptualization: SJL, JWS. Investigation: SJL, JWS. Writing-original draft: SJL. Writing-review and editing: JWS. All authors have read and approved the final manuscript. Fig. 1.Coronal preoperative computed tomography image showing complete intestinal obstruction and diffuse bowel distension. (A) The black arrow indicates the colonic endometrioma. (B) Extensive bowel dilatation. Fig. 2.Sigmoidoscopy showing an ulceroinfiltrative tumor with an irregular surface, swelling, and hemorrhage, resulting in luminal narrowing of the sigmoid colon. - 1. International Working Group of AAGL, ESGE, ESHRE and WES; Tomassetti C, Johnson NP, Petrozza J, Abrao MS, Einarsson JI, et al. 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Coronal preoperative computed tomography image showing complete intestinal obstruction and diffuse bowel distension. (A) The black arrow indicates the colonic endometrioma. (B) Extensive bowel dilatation. Fig. 2. Sigmoidoscopy showing an ulceroinfiltrative tumor with an irregular surface, swelling, and hemorrhage, resulting in luminal narrowing of the sigmoid colon. Fig. 3. Stent placement by fluoroscopy. Solitary intraluminal colonic endometrioma presenting with colonic obstruction: a case report