Deep infiltrating endometriosis of the colon causing cyclic bleeding.
نویسندگان
چکیده
To cite: Ribeiro C, Nogueira F, Guerreiro SC, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2015209464 DESCRIPTION Endometriosis, the presence of functional endometrial tissue outside the uterus, occurs in about 3–10% of women of reproductive age and is a cause of chronic pelvic pain and infertility for some. Bowel involvement may be present in about 5–10% of these women, mostly affecting the rectum and distal sigmoid (over 80% of cases), and, more infrequently, the appendix, ileum and caecum. The most common lesions involve only the serosa (endometriotic implants) but they can penetrate the muscular layers of the wall, in which case they are called deep infiltrating endometriosis. We present a case of a 42-year-old mother of two children, who presented with irregular menstrual cycles and mild dysmenorrhoea that started with painless rectal bleeding, which characteristically coincided with her menstrual periods. Physical examination was unremarkable as were laboratory studies. Colonoscopy (figure 1A) showed a submucosal mass focally eroding the mucosa in the sigmoid colon and biopsies were not conclusive but suggested the presence of a connective tissue neoplasia with questionable smooth muscle differentiation. Endoscopic ultrasound (figure 1B) revealed a disruption of the wall, particularly in the muscle and submucosal layers, by a 25 mm heterogeneous lesion. Subsequent abdominal CT scan confirmed asymmetrical thickening of the left wall of the sigmoid colon and MRI did not add more information. Owing to this diagnostic uncertainty we decided to perform a sigmoidectomy, which was uneventful (figure 2A, B). A definitive histological examination revealed deep infiltrating endometriosis of the colon. Hormonal therapy was not initiated as there was no evidence of other endometriomas; also, the patient was asymptomatic.
منابع مشابه
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Background The performance of TVS, TRS and MRI for the diagnosis of DIE have been separately reported in earlier studies. However, the three methods have not been concurrently compared in terms of their overall performance and classified results as per different anatomical locations of DIE lesions in a large study population. This study was an attempt to compare pelvic magnetic resonance imagin...
متن کاملI-59: Diagnostic Accuracy of Physical Examination,Transvaginal Sonography, RectalEndoscopic Sonography, and Magnetic ResonanceImaging to Diagnose Deep InfiltratingEndometriosis
Background: To compare the value of physical examination, transvaginal sonography (TVS), rectal endoscopic sonography (RES), and magnetic resonance imaging (MRI) for the assessment of different locations of deep infiltrating endometriosis (DIE). Materials and Methods: Ninety-two consecutive patients with clinical evidence of pelvic endometriosis. Physical examination, TVS, RES, and MRI, perform...
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متن کامل
Mapping of bowel occult microscopic endometriosis implants surrounding deep endometriosis nodules infiltrating the bowel.
OBJECTIVE To provide a mapping of bowel occult microscopic endometriosis implants from colorectal specimens removed from patients who had undergone colorectal resection for deep endometriosis infiltrating the rectum. DESIGN A series of consecutive patients with deep endometriosis infiltrating the rectum or/and sigmoid colon, between January 2013 and December 2013. SETTING University tertiar...
متن کاملLaparoscopic rectal resection of deep infiltrating endometriosis.
PURPOSE Deep infiltrating endometriosis with colorectal involvement is a complex disorder, often requiring segmental bowel resection. Complete removal of all visible lesions is considered the adequate treatment of infiltrating endometriosis in order to reduce recurrence. In this article, we describe our experience with laparoscopic management of deep infiltrating endometriosis with involvement ...
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ورودعنوان ژورنال:
- BMJ case reports
دوره 2015 شماره
صفحات -
تاریخ انتشار 2015