Lower Gastrointestinal Tract Bleeding Caused by Ovarian Endometriosis Invading the Ileum

A 50-year-old woman suffered from painless lower gastrointestinal tract bleeding. Emergent colonoscopy disclosed fresh-blood coating throughout the whole course up to cecum, while no active bleeding site was found. At laparotomy, one active bleeder in the ileum with one cystic tumor adhesive to it was found. The tumor was histopathologically an ovarian endometrioma invading the serosa of the ileum, and it resulted in intestinal mucosal tearing to bleed. The patient, a victim of liver cirrhosis associated with chronic hepatitis C, finally died of wound infection and liver failure 3 weeks after operation. According to the literature, most cases of ileocecal endometriosis are asymptomatic, although some might experience abdominal pain and or intestinal obstruction. With this case report, we suggest that an ovarian endometriosis invading the intestine should be included in the differential diagnosis of lower gastrointestinal tract bleeding, especially when the exact cause of bleeding remains unknown in a female patient.