Asad Rehman, DO1, Joseph Namey, DO2, Muhammad Khan, MD, MPH1, Meir Mizrahi, MD1 1HCA West Florida Largo Medical Center, Largo, FL; 2Largo Medical Center, Largo, FL
Introduction: Endometriosis refers to inflammation caused by active endometrium outside of the uterus. Colonic involvement can give rise to various complications, such as luminal narrowing, obstruction, and even perforation; all which can be avoided with endoscopic mucosal resection (EMR). Our case shows that endometrial implants in the colon can present similarly to colon cancer and should be considered as a potential etiology of findings on colonoscopy.
Case Description/Methods: A 45-year old female (G4P3) presented with a several month history of left lower quadrant abdominal pain, bloating and multiple episodes of blood per rectum. Past medical history was significant for endometriosis with hysterectomy, tubal ligation, and idiopathic thrombocytopenic purpura. She was referred for a rectosigmoid polyp concerning for malignancy. The mass found was a firm, rubbery, 15mm, exophytic sessile polyp positioned on the acute fold of the sigmoid colon. Using an underwater technique, piecemeal EMR was performed. Argon plasma coagulation (APC) ablation was performed on residual adjacent tissue and the resection bed. Histopathology showed endometriosis involving the muscularis propria and submucosa negative for hyperplastic polyp, adenoma or malignancy. Endometriosis stain was positive for CK7 and PAX-8 and negative for CK20 and CDX-2 confirming the diagnosis. Hormone therapy was initiated and showed significant improvement in symptoms.
Discussion: Endometriosis can affect essentially any organ. Intestinal involvement usually presents with symptoms and gross appearance similar to many disorders including cancer or leiomyoma, such as in our case. Endometriosis usually involves serosa and subserosa. When there is deep invasion into the muscularis propria and submucosa, it can be mistaken for colon cancer, delaying and complicating diagnosis. The gold standard for diagnosing endometriosis is laparoscopy, but colonoscopy can provide direct visualization of lesions with the opportunity for EMR and confirmatory biopsy. As rectosigmoid endometriosis surgery is associated with high rates of complication when compared to other parts of the colon, EMR was preferred in our case. Hormone therapy can help prolong the recurrence interval between resection and recurrence, but has no effect on lesion size. A multidisciplinary approach to intestinal endometriomas with hormone therapy combined with EMR can lower recurrence, remove lesions completely, and help patients avoid endometrioma complications and high-risk surgical procedures.
Figure: Image a: Lesion development prior to EMR. b: Cap-assisted underwater technique piecemeal EMR performed using hot 20 mm and 10 mm snares. c: Lesion was completely removed, retrieved, and APC ablation was performed on residual tissue adjacent to the resection site, as well as resection bed.
Disclosures:
Asad Rehman indicated no relevant financial relationships.
Joseph Namey indicated no relevant financial relationships.
Muhammad Khan indicated no relevant financial relationships.
Meir Mizrahi indicated no relevant financial relationships.
Asad Rehman, DO1, Joseph Namey, DO2, Muhammad Khan, MD, MPH1, Meir Mizrahi, MD1. E0112 - Endometrioma Presenting as a Sigmoid Colon Polyp, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.
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