Colonic Endometriosis Mimicking Colonic Carcinoma

摘要

Introduction Endometriosis was first defined in 1860 by von Rokitansky as the presence of functioning endometrial glands and stroma outside the uterine cavity. While ectopic endometrial tissues are frequently observed on the surfaces of the uterus and adnexae , they might rarely be observed on the serosal surfaces of bowel and laparotomy incisions, in the lungs, bones and in the urinary tract [123]. Extra-pelvic endometriosis is most frequently seen in bowels, which is usually asymptomatic. However, bowel endometriosis might show non-specific symptoms such as abdominal colic-like pain, nausea, vomiting, constipation, diarrhea and rectal bleeding. From 0.7% - 2.5% of patients require bowel resection for symptomatic lesions [6].We present a case of sigmoid endometriosis causing intestinal obstruction mimicking carcinoma of the sigmoid colon. Case Report This is a case of a 41-year-old lady who had endometriosis for 18 years. The patient was well till three months prior to her symptoms where she started to have bleeding per rectum , which was bright red coming during the days of menstrual period, 4-6 times per day during passing stool and in between, minimal in quantity and covering the stool sometimes. It was associating with mucous with painful defecation. She was complaining also of abdominal pain which was dull and generalized and was more severe during passing stool. It was severe enough to make her stay for half an hour in the washroom. There was no history of bleeding tendency, bleeding from other sites, melena, or hematemesis. She had regular menses. Systemic review was unremarkable.On examination, she looked well, not in pain and she was not pale. She was not tachycardic and she was afebrile. Abdominal examination revealed soft abdomen and no tenderness. Per rectal examination was normal and no blood was seen. Blood Chemistry, complete blood count, Coagulation profile, alfa-fetoprotein and carcinoembryonic antigen were within normal limits. Colonoscopy showed stricture in the sigmoid colon which cannot be advanced to the sigmoid colon. Barium study showed area of constant narrowing at the sigmoid colon (Figure 1).