3080 Intestinal Endometriosis: A Case of Mistaken Identity

INTRODUCTION: Intestinal involvement is seen in 3-30% of the cases of endometriosis with the rectum and sigmoid colon being frequently affected (75-90%) followed by distal ileum (2–16%) and appendix (3–18%). In addition to the classic triad of pelvic disease, the presentation may vary from being asymptomatic to rectal bleeding, bowel obstruction and rarely perforation. In the majority of the cases, the mucosa is spared with involvement limited to serosa and muscularis propria. The median age of diagnosis is 34-40 years, but reports of diagnosis in the peri- and post-menopausal women are known to exist in literature. CASE DESCRIPTION/METHODS: A 55-year-old Caucasian female presented with intermittent bleeding per rectum and abdominal pain for a period of two months with a history of irritable bowel syndrome and anemia. She denied any weight loss or loss of appetite. The examination was unremarkable except for pallor and tenderness in the lower quadrant and laboratory investigations revealed microcytic anemia. Colonoscopy was significant for a 1.5 cm mass in the sigmoid colon. Biopsy of the mass showed endometrial foci and stroma with signs of transmural involvement but was negative for signs of malignancy. The patient was managed with hormonal suppression therapy leading to resolution of abdominal symptoms. DISCUSSION: Intestinal endometriosis mimics a broad spectrum of diseases; inflammatory bowel disease neoplasms, colitis, diverticular disease, and infection. The clinical picture along with its overlapping clinical, endoscopic and radiological findings add to the diagnostic conundrum. It is essential to differentiate it from colon adenocarcinoma, the third most common type of cancer in women, to avoid unwarranted diagnostic and therapeutic interventions. The literature regarding standardized workup and treatment is limited and continues to be a topic of research.