P2067 - Intramural Endometriosis of the Sigmoid Colon Masquerading as Diverticulitis: A Diagnostic Challenge

Caleb Rashidian, DO¹, Aaron Rampersad, DO¹, Anjani Jammula, MD², Patrick J.. Culumovic, MD^1
1Prisma Health Greenville Memorial Hospital, Greenville, SC; ²Prisma Health, Greenville, SC

Introduction: Due to its tendency to invade surrounding tissue, endometriosis can represent a major diagnostic challenge. This case presents an instance of endometriosis involving the gastrointestinal (GI) tract causing a sigmoid stricture in a postmenopausal female on hormone replacement therapy (HRT), emphasizing the importance of considering endometriosis in the differential diagnosis of acute GI pathologies.

Case Description/Methods: A 48-year-old female with a history of irritable bowel syndrome (IBS), and endometriosis s/p total abdominal hysterectomy and patrial oophorectomy at age 35 was started on HRT by her PCP for menopausal symptoms at 48. Within two months, the patient developed episodic left lower quadrant abdominal pain, nausea/vomiting, and severe constipation. Her PCP started her on empiric Rifaximin for suspected SIBO. After transient improvement, her symptoms returned before a scheduled outpatient colonoscopy, which demonstrated grossly congested mucosa with focal erosions concerning for diverticulitis with procedure aborted due to an edematous and narrow sigmoid. While cross sectional imaging with a CT scan identified no acute pathology, she was treated with Ciprofloxacin and Metronidazole for possible acute diverticulitis but continued to have cyclical symptoms. During a subsequent Emergency Room visit 5 weeks later, a repeat CT scan found inflammation in the sigmoid colon, likely diverticulitis, and the patient was treated with a 2nd course of Ciprofloxacin and Metronidazole. Repeat colonoscopy, approximately two months after the initial attempt, demonstrated grossly congested mucosa with tortuosity of sigmoid colon again requiring abortion of procedure. Mucosal biopsies showed evidence of microscopic colitis. A virtual colonoscopy identified a soft tissue/endometrial implant along the anterior wall at the rectosigmoid junction. The patient underwent an elective sigmoid colonic resection with colorectal surgery and pathology confirmed intramural and serosal endometriosis. Shortly after, OBGYN discontinued HRT and the patient noted a complete resolution of symptoms.

Discussion: Endometriosis can mimic other acute GI pathologies, such as malignancy, infectious, ischemic, or inflammatory conditions. Here, intramural sigmoid colonic endometriosis mimicking complicated diverticulitis led to a stricture in a postmenopausal woman on HRT, underscoring the significance of considering endometriosis as a cause of GI symptoms.


Disclosures:


Caleb Rashidian, DO¹, Aaron Rampersad, DO¹, Anjani Jammula, MD², Patrick J.. Culumovic, MD¹. P2067 - Intramural Endometriosis of the Sigmoid Colon Masquerading as Diverticulitis: A Diagnostic Challenge, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.