Introduction: Screening colonoscopy can occasionally reveal unexpected pathologies, beyond its primary goal of detecting neoplastic lesions. We present a case of incidental sigmoid endometriosis in a 52-year-old asymptomatic woman who had undergone hysterectomy, discovered during screening colonoscopy. This report highlights the benefit of screening procedures in recognizing atypical findings, even in the absence of symptoms.
Case Description/Methods: A 52-year-old asymptomatic woman with a history of hysterectomy underwent screening colonoscopy, where a large lobulated sigmoid mass measuring 20 cm was incidentally detected, located 20 cm from the anal verge. Multiple biopsies were performed, revealing a hyperplastic mass with irregular margins in the sigmoid colon. The case was referred to a colorectal surgeon, and an open low anterior resection with primary stapled anastomosis was performed.
The final pathology report showed benign endometrial glands and stroma with patchy involvement, confirming a diagnosis of endometriosis of the sigmoid wall.
Discussion: Endometriosis is a gynecological condition that presents as endometrial-like tissue outside the uterus and induces a chronic inflammatory reaction. Gastrointestinal Endometriosis is extremely rare in a patient who had a prior hysterectomy, and is more frequently expected to be located in the recto-sigmoid portion of the colon. Colorectal involvement usually results in alterations of bowel habits, tenesmus, dyschezia, and, rarely, rectal bleeding, but is unusual to be silent. A precise diagnosis of the presence, location, and extent of endometriosis is necessary to plan surgical treatment. Multidisciplinary laparoscopic treatment has become the standard of care. Depending on the size of the lesion and site of involvement, full-thickness disc excision or bowel resection needs to be performed by an experienced colorectal surgeon.
Figure: A large lobulated sigmoid mass measuring 20 cm, located 20 cm from the anal verge.
Khalid Aloum indicated no relevant financial relationships.
Khaled Elfert indicated no relevant financial relationships.
Suut Gokturk indicated no relevant financial relationships.
Khalid Aloum, MD1, Khaled Elfert, MD1, Suut Gokturk, MD2. P3055 - Incidental Sigmoid Endometriosis in a Woman With a Prior Hysterectomy, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.