J Korean Soc Radiol.  2016 Sep;75(3):203-207. 10.3348/jksr.2016.75.3.203.

Descending Colon Endometriosis Misdiagnosed as Diverticulitis: A Case Report

• Kim J
• Kim MJ
• Ha HI
• Lee K
• Min SK

• KMID: 2349326
• DOI: http://doi.org/10.3348/jksr.2016.75.3.203

Abstract

Endometriosis is defined as the presence of ectopic endometrial tissue outside the uterus. It is a common disease in menstruating females and intestinal involvement is not uncommon. Intestinal endometriosis most commonly involves the sigmoid colon, rectum, ileum, appendix, and cecum. However, the descending colon is a rare site of intestinal endometriosis. Although computed tomography (CT) findings of bowel endometriosis have been presented in several articles, there has been no report describing the CT findings of descending colon endometriosis above the pelvic cavity. Here, we report a rare case of descending colon endometriosis located in the retroperitoneal space, in which the initial impression was acute colonic diverticulitis with a small abscess on preoperative multidetector CT.

MeSH Terms

Abdominal Pain
Abscess
Appendix
Cecum
Colon
Colon, Descending*
Colon, Sigmoid
Diverticulitis*
Diverticulitis, Colonic
Endometriosis*
Female
Humans
Ileum
Rectum
Retroperitoneal Space
Uterus

Figure

• 

  Fig. 1 Descending colon endometriosis in a 47-year-old female. A. Contrast-enhanced axial CT scan shows a 2.5-cm exophytic hypodense lesion (asterisk) with a peripheral enhancing rim on the antimesenteric border of the descending colon. Adjacent colonic wall thickening (open arrow), pericolic fat infiltration (arrows), and thickening of the left anterior renal fascia and lateroconal fascia are also seen. B. Unenhanced axial CT scan reveals a homogeneous hypodense lesion (asterisk) without hemorrhage. C. Contrast-enhanced CT with coronal reformatted image demonstrates colonic wall thickening (open arrows) with a 3-cm exophytic hypodense nodule (asterisk) on the antimesenteric border of descending colon, and pericolic fat infiltration (arrow). D. On cross section, the surgical specimens taken from the segmentally resected descending colon show an approximately 3.0 × 2.5 × 1.5-cm whitish mass with focal hemorrhage (open arrowheads), which is densely adhered to the serosal surface of the colon. The mucosa of the colon is intact. E. Low-power microscopic image shows hemorrhage (H) and endometrial glands (black arrowheads) with stroma (black arrows) embedded in the hypertrophied muscle layer of the descending colon (hematoxylin and eosin stain, × 40). CT = computed tomography

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