P1977 - A Rare Case of Endometriosis of the Sigmoid Colon

Pujyitha Mandiga, MD¹, Nivin Salin, MD², Issam Turk, MD^3
1Ascension Macomb-Oakland Hospital, Parker, CO; ²Henry Ford Health, Madison Heights, MI; ³Ascension Medical Group, Rochester Hills, MI

Introduction: Endometriosis is a condition characterized by ectopic implantation of endometrial tissue (endometrial glands and stroma) beyond the confines of the uterine cavity. The exact frequency is hindered by the fact that many women with endometriosis remain asymptomatic and undiagnosed. Current estimates suggest 10-15% of women of reproductive age will have endometriosis (1). The ectopic presence of endometrial tissue can lead to a range of symptoms, including pelvic pain, painful menstrual periods and infertility. Severity can vary and in some cases could be asymptomatic.



While endometrial tissue typically confines itself to the pelvic region, it is rare to encounter its infiltration into the colon. This becomes more exceptional when the growth manages to penetrate the entire mucosa of the sigmoid colon.



In light of the rarity of such occurrences, we present a case of a young woman with endometriosis of the sigmoid colon.

Case Description/Methods: A 30 year-old woman with morbid obesity, endometriosis presents with progressive worsening of sharp, lower abdominal pain, constipation with bright red blood per rectum. Initial labs indicated microcytic anemia with Hgb of 10.7 CT abdomen pelvis revealed GE junction thickening and extensive endometriosis with adhesions inseparable from the sigmoid colon and a suspected hydrosalpinx (Image 1). A sigmoidoscopy showed extrinsic compression and intraluminal narrowing in the sigmoid colon, attributed to the bulky endometriosis. There was one specific area within the rectosigmoid junction that showed abnormal tissue with erosion and stigmata of recent bleeding likely consistent with endometriosis with intramural penetration (Image 2, 3). Biopsy confirmed the diagnosis of endometriosis. A multidisciplinary team recommended surgical excision, but concerns about sparing the uterus led to a challenging decision. Ultimately, the patient opted for outpatient follow-up with potential future consideration of surgery.

Discussion: This extraordinary case underscores the complexity and varied presentation of endometriosis, urging a deeper exploration into its pathogenesis and the implications for both diagnosis and treatment



Several theories proposed about the pathogenesis of endometriosis, but none of them were conclusive and able to explain the range of the clinical pictures of the disease. We are hoping with this case to shed light on the intricate puzzle of endometriosis so we get closer to unraveling its mystery and advancing more targeted and effective treatment.



Disclosures:


Pujyitha Mandiga, MD¹, Nivin Salin, MD², Issam Turk, MD³. P1977 - A Rare Case of Endometriosis of the Sigmoid Colon, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.