Transmural Polypoid Endometriosis of the Sigmoid Colon

Excerpt

A 48-year-old female presented with a history of chronic constipation and intermittent lower gastrointestinal bleeding after bowel movements. She reported that bleeding began in her 20’s but recently started experiencing constipation. She denied any associated fever, chills, or weight loss. The patient denied smoking, alcohol, and illicit drug use. Physical examination was normal. Pertinent laboratory tests were within reference range. Colonoscopy was performed which revealed mild melanosis in the sigmoid colon. A 4-cm recto-sigmoid polypoid lesion with overlying normal mucosa was identified and biopsied (Fig. 1a). Biopsy showed fragments of colonic mucosa with no significant pathologic findings. Endoscopic ultrasound (EUS) demonstrated a mass in the recto-sigmoid colon arising from the muscularis propria of the colon (Fig. 1b). The mass was hypoechoic and measured 15.5-mm on the long axis and 6.2-mm on the short axis. Invasion into the serosa was also noted, as well as no evidence of adenopathy (T4 by EUS criteria). The patient subsequently underwent an exploratory laparotomy and procto-sigmoidoctomy for resection of the recto-sigmoid mass measuring 10-cm in length by 5-cm in average circumference (Fig. 2). Surgical histopathology of the sigmoid mass revealed endometriosis present in the submucosa, muscularis propria, and infiltrating into the sub-serosa.

…