Rectal bleeding from colon endometriosis may be difficult to differentiate from that of colon cancer

The gastrointestinal tract is the most common site extrapelvic endometriosis. Prevalence is 5–15% in the female population. The rectum and sigmoid colon are the most commonly involved areas (75–90%), it appears in the distal ileum in 2–16% and in the appendix in 3–18%. The serosa and the muscular propria are usually involved, the mucosa is very rarely affected. The colon endometriosis is presented with different symptoms which can be cyclical in about 40% of patients. The clinical, radiological and endoscopic picture may refer to neoplasm, IBD, postirradiation colitis, ischemic colitis, diverticular disease and infection. Endoscopic diagnosis of colon endometriosis may be performed if the mucosa is also involved. MRI seems to be the most sensitive technique for endometriosis, while the “gold standard” for definite diagnosis is laparotomy or laparoscopy. Surgical objective is the total resection of endometriosis.

The authors present a case with colon endometriosis.

A 49 years old woman was admitted to the hospital with rectal bleeding and abdominal pain. The colonoscopy showed on the rectovaginal septum a lesion mimicing cancer. Considering the histological report which demonstrated an adenoma tubulare and the frequent bleedings as well as the precancerous nature of the lesion we decided on surgery. Rectum resection of Dixon type and a right side ovarectomy (due to pelvic propagation) were performed. The patient's recovery was uneventful. The final histology proved rectum endometriosis spreaded to the ovarium as well. This case shows that in the background of gastrointestinal bleeding other rare diseases may occur.