Endometrioma of the sigmoid colon presenting with intestinal obstruction.

We read with great interest the review article “Shining light in a dark landscape: MRI evaluation of unusual localization of endometriosis” by Gui et al. (1) in the July-August 2017 issue of Diagnostic and Interventional Radiology; we congratulate the authors on their great work. However, we noticed that they omitted an atypical clinical presentation of intestinal involvement of endometriosis; we would like to comment on the article with an exemplary case. Intestinal endometriosis has usually been reported as a single case or small case series, although not rare (2, 3). The lower rectosigmoid colon is the most common localization of the disease, followed by the rectovaginal septum, the distal part of the small intestine, the cecum, and the appendix. The symptoms of intestinal involvement depend on the severity and location of the disease. The severity of disease depends on the depth of invasion into the bowel wall, and typically occurs with chronic symptoms. Although deep infiltrating endometriosis with intestinal serosal involvement is not uncommon as stated in the introduction section of the article, endometriosis causing acute large bowel obstruction is rare and can be confused with a wide range of other diseases, such as carcinoma or Crohn’s disease (4). The typical magnetic resonance imaging findings of the disease include a hypointense mass on T2-weighted images due to induced fibrosis and hypertrophy of the muscularis mucosa with or without hyperintense hemorrhagic foci on T1-weighted images with fat suppression, abutting the