alexa Rectosigmoid Endometriosis Mimicking Cancer: Presenting with Intestinal Obstruction | Open Access Journals
ISSN: 2327-4972
Family Medicine & Medical Science Research
Make the best use of Scientific Research and information from our 700+ peer reviewed, Open Access Journals that operates with the help of 50,000+ Editorial Board Members and esteemed reviewers and 1000+ Scientific associations in Medical, Clinical, Pharmaceutical, Engineering, Technology and Management Fields.
Meet Inspiring Speakers and Experts at our 3000+ Global Conferenceseries Events with over 600+ Conferences, 1200+ Symposiums and 1200+ Workshops on
Medical, Pharma, Engineering, Science, Technology and Business

Rectosigmoid Endometriosis Mimicking Cancer: Presenting with Intestinal Obstruction

Ying-Li Lin1 and Chao-Hung Yu2*
1Department of Family Medicine, Changhua Christian Hospital, Taiwan
2Division of Cardiovascular Medicine, Department of Internal Medicine, Changhua, Christian Hospital, Taiwan
Corresponding Author : Chao-Hung Yu
Division of Cardiovascular Medicine
Department of Internal medicine, Changhua
Christian Hospital, Taiwan
Tel: 886983901948
Received: December 15, 2015; Accepted: January 04, 2016; Published: January 11, 2016
Citation: Lin YL, Yu CH (2016) Rectosigmoid Endometriosis Mimicking Cancer; Presenting with Intestinal Obstruction. Fam Med Med Sci Res 5:197. doi:10.4172/2327-4972.1000197
Copyright: © 2016 Lin YL, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Related article at Pubmed, Scholar Google

Visit for more related articles at Family Medicine & Medical Science Research


Endometriosis is a common benign gynecological disease in women of reproductive age with a variety of clinical presentations ranging from asymptomatic to intractable and intolerance. Intestinal involvement occurs in 3% to 37% of patients with pelvic endometriosis, and rectosigmoid colon is the most frequently involved site [1]. Involvement of the gastrointestinal tract may mimic primary gastrointestinal carcinoma. Bowel obstruction is rare because it usually involves the serous layer, sparing the mucosa. We report a case of a 43-year-old woman presented with gastrointestinalsymptoms of bowel obstruction as the first manifestation of disease and highlight the diagnostic difficulty.

Intestinal endometriosis; Endometriosis; Colon cancer; Bowel obstruction
A previously healthy 43-year-old woman suffered from bowel habit change for months. Initially, she was diagnosed as irritable bowel syndrome and treated at a local medical clinic. The physical examination found normal vital signs, and examination of the abdomen was normal. Colonoscopy indentified a sigmoid ulcerative mass lesion (Figure 1) and tubular adenoma was diagnosed by the histological examination of the endoscopic biopsy specimen. Abdominal computed tomography (CT) showed annular mural thickening of the wall of the rectosigmoid colon, about 4.1 cm in length (Figures 2 and 3). Sigmoid colon cancer was suspected and a laparoscopic assisted low anterior resection of the rectum was planned. At surgery, upper rectal tumor with partial obstruction and right ureter partial obstruction were noted. Frozen section biopsy results showed atypical glands, favored benign, much to the surprise of the treating team. The surgical procedure started with a low anterior resection of the rectum, ending with an end to end colorectal anastomosis and cystoscopy assisted double-J catheter insertion. The final pathologic results showed endometriosis with rectum involvement in mucosa, submucosal, muscular wall and culde- sac. The one regional lymph node also revealed endometriosis. She was discharged without discomfort 8 days later.
Endometriosis is defined as the presence of endometrial tissue and glands outside the uterine cavity. The most widely accepted theory about the pathogenesis of endometriosis is the retrograde menstruation, which explains the presence of endometrial cells on the peritoneal surfaces [2]. The ovaries are the most affected organs, followed by the uterosacral ligaments, the fallopian tubes, and the bowel [3]. Rectosigmoid colon is the most frequently involved site of intestinal endometriosis (73%), followed by the small bowel and the cecal appendix [4]. Patients with bowel involvement can be asymptomatic or they can present with abdominal pain, constipation, diarrhea, change in the form and caliber of stool, tenesmus and rarely hematochezia. A cyclic pattern of abdominal symptoms that correlates with menstruation supports a diagnosis of endometriosis, but these symptoms are easily mistaken for bowel obstruction caused by adhesions, malignancy, or inflammatory bowel disease. Differentiation of the clinical symptom between intestinal endometriosis and primary gastrointestinal carcinoma is difficult and it is a challenge for physicians to make diagnosis.
Endometriosis most often involves the anterior wall of the rectosigmoid colon, and typically produces extrinsic mass effect on the serosa, with the overlying mucosa left intact. The incidence of mucosal involvement by intestinal endometriosis has been estimated by examination of involved resection specimens to be only 30% [1]. A definitive preoperative diagnosis is sometimes difficult because an endoscopic biopsy has limited efficacy as a diagnostic tool. Recognition of the radiologic appearance of gastrointestinal involvement may be the clue for diagnosis. Endometriosis may manifest as a polypoid mass extending into the lumen of the colon, a stricture or a short annular lesion [5,6] . In these cases, it may be impossible to distinguish endometriosis from carcinoma at radiography. Many cases of intestinal endometriosis are still diagnosed during operation. Because pelvic endometriosis sometimes involves the intestinal tract and mimics a malignant tumor in a female case, an intraoperative histological examination should therefore be considered for conclusive diagnosis during surgery for colorectal cancer.
Treatment options consist of medical and surgical treatment. Most patients are treated medically with hormone therapy to control the cyclic tissue proliferation and bleeding that cause the symptoms. The medications used to treat endometriosis are danazol, highdose progestins, and GnRH agonists, all of which have equivalent efficiency [7]. Laparoscopic or open surgical bowel resection may be necessary in selected patients in whom endometriosis has involved the gastrointestinal tract and caused obstruction or severe bleeding [8]. When it is impossible to differentiate between endometriosis and a neoplasm of the bowel, surgical intervention is also necessary.
In our patient, the atypical presentation included clinical symptoms of bowel obstruction and annular mural thickening lesion at abdominal computed tomography (CT), led to be mistaken as primary gastrointestinal carcinoma. Surgical intervention was necessary in this case because bowel obstruction developed and differentiation between endometriosis and a neoplasm of the bowel was difficult.
Diagnosis of intestinal endometriosis is difficult. Based on clinical symptoms, endoscopic procedure and radiological findings, it can be easily mistaken for malignancy. Familiarity with the pattern of gastrointestinal tract involvement is important for accurate diagnosis. Most patients can be treated medically with hormone therapy, and laparoscopic or open surgery is usually successful if medical management fails.

Figures at a glance

Figure Figure Figure
Figure 1 Figure 2 Figure 3
Select your language of interest to view the total content in your interested language
Post your comment

Share This Article

Relevant Topics

Recommended Conferences

Article Usage

  • Total views: 7809
  • [From(publication date):
    February-2016 - Jul 25, 2017]
  • Breakdown by view type
  • HTML page views : 7750
  • PDF downloads :59

Post your comment

captcha   Reload  Can't read the image? click here to refresh

Peer Reviewed Journals
Make the best use of Scientific Research and information from our 700 + peer reviewed, Open Access Journals
International Conferences 2017-18
Meet Inspiring Speakers and Experts at our 3000+ Global Annual Meetings

Contact Us

Agri, Food, Aqua and Veterinary Science Journals

Dr. Krish

1-702-714-7001 Extn: 9040

Clinical and Biochemistry Journals

Datta A

1-702-714-7001Extn: 9037

Business & Management Journals


1-702-714-7001Extn: 9042

Chemical Engineering and Chemistry Journals

Gabriel Shaw

1-702-714-7001 Extn: 9040

Earth & Environmental Sciences

Katie Wilson

1-702-714-7001Extn: 9042

Engineering Journals

James Franklin

1-702-714-7001Extn: 9042

General Science and Health care Journals

Andrea Jason

1-702-714-7001Extn: 9043

Genetics and Molecular Biology Journals

Anna Melissa

1-702-714-7001 Extn: 9006

Immunology & Microbiology Journals

David Gorantl

1-702-714-7001Extn: 9014

Informatics Journals

Stephanie Skinner

1-702-714-7001Extn: 9039

Material Sciences Journals

Rachle Green

1-702-714-7001Extn: 9039

Mathematics and Physics Journals

Jim Willison

1-702-714-7001 Extn: 9042

Medical Journals

Nimmi Anna

1-702-714-7001 Extn: 9038

Neuroscience & Psychology Journals

Nathan T

1-702-714-7001Extn: 9041

Pharmaceutical Sciences Journals

John Behannon

1-702-714-7001Extn: 9007

Social & Political Science Journals

Steve Harry

1-702-714-7001 Extn: 9042

© 2008-2017 OMICS International - Open Access Publisher. Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version