Deeply infiltrating endometriosis of the sigmoid and lymph nodes simulating obstructive neoplasm

A rare case of endometriosis of the sigmoid with lymph node involvement is described in a 35-yea-rold patient. The patient presented with a 12-month history of abdominal pain and diarrhoea with catamenial aggravation. A full clinical and laboratory investigation was performed with normal results, with the exception of the tumour marker CA-125 which was elevated. An abdominal CT scan demonstrated an eccentric bowel wall thickening of the sigmoid colon. Colonoscopy revealed extensive stenosis of the bowel lumen covered by normal mucosa. The histopathology results of an endoscopic biopsy were inconclusive in regard to the nature of the obstruction. Preoperative assessment excluded colonic adenocarcinoma but could not rule out the possibility of a gastrointestinal stromal tumour (GIST) or other type of tumour. Nevertheless, the diagnosis of endometriosis appeared more likely. Intraoperatively, a solid, hard tumour of the sigmoid colon was palpated with a jejunal loop attached to it; consequently, sigmoidectomy for malignancy was decided as the optimal plan of action. There was no evidence of additional pathology in the abdominal cavity. Histology of the specimen revealed intramural endometriosis of the sigmoid with involvement of two regional nodes. Treatment options for large bowel endometriosis include hormonal manipulation with additional surgical resection depending on the patient’s age, the severity and the potential complications of the disease. Similar content being viewed by others

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