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by claude@2026-06, 2026-06-13
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This case report describes rare intestinal endometriosis in a 45-year-old woman presenting with melena in Japan, investigated with barium enema, colonoscopy, and CT, which showed a cecal submucosal-like lesion plus a slightly enlarged uterus and a left ovarian cyst, along with a history of dysmenorrhea. Surgery found a fist-sized swollen uterus adhered to the anterior rectal wall, a large “chocolate cyst” of the left ovary, and a thumb-sized cecal tumor-like lesion with an absent appendix, leading to ileocecal excision and total hysterectomy with excision of uterine supports. Histopathology diagnosed adenomyosis uteri and endometriosis of the left ovary and cecum, with cecal involvement extending from serosa to the submucosal layer around an atrophied appendix. The paper is limited to a single observational case and provides no broader comparative or experimental evidence. This paper is centrally about endometriosis — it specifically reports cecal endometriosis presenting with melena and confirms concurrent adenomyosis on histopathology.
Abstract
We rarely encounter endometriosis of the intestine, especially that of the cecum in Japan. This paper describes such a rare case of endometriosis of the cecum. A 45-year-old woman was seen at the hospital because of melena. Barium enema did not visualize the appendix but showed a 3.5×2.5cm tumor shadow in the cecum. Colonoscopy revealed an elevated lesion like a submucosal tumor in the same region. CT exhibited a slightly swollen uterus and cystic lesion in the left ovary. In addition, the patient had been suffering from dysmenorrhea. Thus, endometriosis of the cecum was suspected and operation was carried out. During surgery it was found that the uterus swelled to be a fist-size, and firmly adhered to anterior wall of the rectum, the left ovary was a chocolate cyst with the size of infant fist, and a tip of the thumb-sized tumor was palpated in the cecum, however, the apendix could not be found. Ileocecal excision, total hysterectomy, excision of bilateral uterine supports were carried out. Histpathologically the patient was diagnosed as adenomyosis uteri and endometriosis of the left ovary and cecum. The cecum part extended from serosa to submucosal layer, as if it winded around the atrophied appendix. The patient has a symptom-free daily life, as of 7 months after the operation.
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A CASE OF ENDMETRIOSIS OF THE CECUM PRESENTING WITH MELENA
1993 Volume 54 Issue 1 Pages 160-163
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Abstract
We rarely encounter endometriosis of the intestine, especially that of the cecum in Japan. This paper describes such a rare case of endometriosis of the cecum.
A 45-year-old woman was seen at the hospital because of melena. Barium enema did not visualize the appendix but showed a 3.5×2.5cm tumor shadow in the cecum. Colonoscopy revealed an elevated lesion like a submucosal tumor in the same region. CT exhibited a slightly swollen uterus and cystic lesion in the left ovary. In addition, the patient had been suffering from dysmenorrhea. Thus, endometriosis of the cecum was suspected and operation was carried out. During surgery it was found that the uterus swelled to be a fist-size, and firmly adhered to anterior wall of the rectum, the left ovary was a chocolate cyst with the size of infant fist, and a tip of the thumb-sized tumor was palpated in the cecum, however, the apendix could not be found. Ileocecal excision, total hysterectomy, excision of bilateral uterine supports were carried out. Histpathologically the patient was diagnosed as adenomyosis uteri and endometriosis of the left ovary and cecum. The cecum part extended from serosa to submucosal layer, as if it winded around the atrophied appendix. The patient has a symptom-free daily life, as of 7 months after the operation.
A 45-year-old woman was seen at the hospital because of melena. Barium enema did not visualize the appendix but showed a 3.5×2.5cm tumor shadow in the cecum. Colonoscopy revealed an elevated lesion like a submucosal tumor in the same region. CT exhibited a slightly swollen uterus and cystic lesion in the left ovary. In addition, the patient had been suffering from dysmenorrhea. Thus, endometriosis of the cecum was suspected and operation was carried out. During surgery it was found that the uterus swelled to be a fist-size, and firmly adhered to anterior wall of the rectum, the left ovary was a chocolate cyst with the size of infant fist, and a tip of the thumb-sized tumor was palpated in the cecum, however, the apendix could not be found. Ileocecal excision, total hysterectomy, excision of bilateral uterine supports were carried out. Histpathologically the patient was diagnosed as adenomyosis uteri and endometriosis of the left ovary and cecum. The cecum part extended from serosa to submucosal layer, as if it winded around the atrophied appendix. The patient has a symptom-free daily life, as of 7 months after the operation.
© Japan Surgical Association
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