Bowel endometriosis treated with simultaneous ileocecal and rectal resection

Abstract

A 43-year-old female noticed hematochezia and lower-right abdominal pain during menstruation. Her family doctor detected a mass by computed tomography at the ileocecum. She was referred to our hospital and colonoscopy was performed. We observed extrinsic pressure resulting in mucosal change at the ileocecum. We also observed a submucosal tumor-like lesion at the rectosigmoid. We performed biopsy from both lesions, both were benign. Ileocecal resection and rectal low anterior resection were performed for diagnosis. Redness, induration and serosal dimpling were recognized at the ileocecum, rectosigmoid and upper rectum. All lesions had endometorial tissue in muscular layer, so pathological diagnosis was bowel endometriosis. Bowel endometriosis occurring in multiple parts and where two colectomies were performed simultaneously is very rare. To determine the optimal method of treatment for the bowel endometriosis, detailed preoperative examination must be performed, specifically complete surgical resection of the lesion for definite diagnosis.

Figure 1:

(a) Endoscopic findings of RS: A SMT-like lesion was observed. (b) Endoscopic findings of ileocecum: A salmon roe-like formation of erythrogenic mucosa at the ileum end was observed.

Figure 2:

CT revealed a mass of ileocecum (arrow).

Figure 3:

(a) Resected specimen (rectum): The serosal dimpling was observed. (b) Resected specimen (rectum): A SMT-like lesion was observed.

Figure 4:

(a) Resected specimen (ileocecum): Serosal dimpling was also observed. (b) Resected specimen (ileocecum): A SMT-like lesion was also observed.

Figure 5:

(a) Specimen (rectum): Contractures and ecchymosis were recognized. (b) Specimen (rectum, H.E. staining): Endometrial tissue was found in ecchymosis in muscularis.