Deep Infiltrating Sigmoid Endometriosis: A Rare Case of Obscure Pathogenesis

This paper is a case report of a 31-year-old woman with a single deep infiltrating sigmoid bowel endometriosis lesion causing progressive bowel habit changes worsened around menstruation, with intermittent bloody stools and no other reported pelvic findings. Using preoperative imaging and colonoscopy with nondiagnostic biopsies, followed by laparoscopic sigmoidectomy for possible malignancy, the authors found histology confirming endometriosis infiltrating all bowel layers with local mucosal erosion and endometriosis in 1 of 16 pericolonic lymph nodes; a key observation was an “inwards to outwards” infiltration pattern and macroscopic absence of other lesions during laparoscopy. The authors explicitly note that this dissemination pattern cannot be explained by leading pathogenesis theories such as retrograde menstruation/implantation or coelomic metaplasia, and they also highlight uncertainty about whether lymph node involvement represented primary nodal disease versus spread from the bowel. This paper is centrally about endometriosis — deep infiltrating sigmoid bowel endometriosis with an atypical infiltration pattern and lymph node involvement.

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