Catamenial rectal bleeding due to invasive endometriosis: a case report

Joshua J Keith, Lorenzo O Hernandez, Livia Y Maruoka Nishi, Tarang P Jethwa, Tarang Jethwa, Jason S. Lewis, Jason T Lewis, George G A Pujalte
Journal of medical case reports · 2020 · vol. 14(1) , pp. 61 · doi:10.1186/s13256-020-02386-w · PMID:32456703 · PMC7251904 · W3029220742
article OA: gold CC0 ⤵ 4 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This case report describes a 41-year-old woman with cyclic rectal bleeding diagnosed as invasive intestinal endometriosis with recto-sigmoid stricture, emphasizing its rarity and inclusion in differential diagnoses for premenopausal women.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This case report describes a 41-year-old woman with a prior hysterectomy and left oophorectomy who developed cyclic rectal bleeding and sharp lower abdominal pain 6–8 months earlier, with symptoms occurring for about 1 week each month. Pelvic MRI suggested invasive recto-sigmoid endometriosis, and colonoscopy showed a recto-sigmoid stricture with endometrial implants; biopsy pathology showed colonic mucosa with lamina propria/submucosal congestion, and estrogen receptor immunostaining was negative. The authors note the key caveats that intestinal endometriosis can mimic other conditions and that colonoscopic biopsies are often superficial and may miss deeper endometriotic foci, contributing to potential misdiagnosis. This paper is centrally about endometriosis — specifically a rare presentation of deep infiltrative/invasive intestinal endometriosis causing catamenial rectal bleeding after hysterectomy with unilateral oophorectomy.

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Abstract

BACKGROUND: Although gastrointestinal involvement is the most common site for extra-genital endometriosis, deep infiltrative endometriosis, which affects the mucosal layer, is very rare. CASE PRESENTATION: We present a case of a 41-year-old white woman with cyclic rectal bleeding. Magnetic resonance imaging was done, together with colonoscopy and histologic staining of biopsied samples, which led to the final diagnosis of intestinal invasive endometriosis with recto-sigmoid stricture. Our patient was treated symptomatically with stool softeners. CONCLUSION: This case provides a rare example of catamenial bleeding. It is important to keep invasive endometriosis on the differential diagnosis whenever a premenopausal woman has cyclical rectal bleeding.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Gastrointestinal Hemorrhage Sigmoid Diseases Adult Endometriosis Endometriosis Female Gastrointestinal Hemorrhage Humans Menstruation Disturbances Menstruation Disturbances Rectum Sigmoid Diseases Sigmoid Diseases

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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Cited by (4)

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