Korean J Gastroenterol.  2023 Jan;81(1):46-51. 10.4166/kjg.2022.104.

Diagnosis of Bowel Endometriosis Using Endoscopic Ultrasound-guided Fine Needle Aspiration

• Carvalho AC
• Cardoso R
• Pires F
• Ventura S
• Portela F
• Ministro P
• Silva A

• KMID: 2538688
• DOI: http://doi.org/10.4166/kjg.2022.104

Abstract

Endometriosis is a relatively common gynecological condition in women of reproductive age. The rectosigmoid region is the most commonly affected segment when the gastrointestinal tract is involved. A differential diagnosis of colorectal neoplasia is difficult because of the similar clinical, endoscopic, and radiology findings. A 42-year-old female presented with abdominal distention and was subsequently diagnosed with a large bowel obstruction in the rectum. A temporary colostomy was performed, and endoscopy revealed a rectal mass obstructing the rectum. The biopsy showed normal mucosa, and it was difficult to exclude rectal malignancies even after the imaging workup. Endoscopic ultrasound demonstrated a hypoechoic lesion below the rectal mucosa, and fine needle aspiration confirmed the diagnosis of bowel endometriosis. Bowel endometriosis is a challenging diagnosis. Endoscopic ultrasound-guided fine-needle aspiration is useful for acquiring adequate samples for histological confirmation and a definitive diagnosis of bowel endometriosis.

Keyword

Endometriosis; Endoscopy; Endoscopic ultrasound-guided fine needle aspiration; Intestinal obstruction

Figure

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  Fig. 1 Pelvic CT transversal (A) and coronal (B) images revealing a stenotic lesion in the upper rectum (arrow), without a clear margin from the cervix, with upstream large and small bowel distension.

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  Fig. 2 Rectosigmoidoscopy showing a pseudopolypoid lesion causing a rectal obstruction.

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  Fig. 3 Pelvic MRI T1 (A) and T2 weighted in transversal (B) and sagittal (C) view demonstrating a stenotic lesion (arrows) in the upper rectum and its anatomical relations with the uterus.

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  Fig. 4 Rectal EUS (linear probe) revealing an irregularly shaped hypoechoic and heterogeneous lesion (arrow) extending into the muscular layer of the rectal wall.

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  Fig. 5 Histopathology showing endometrial-type epithelium in the colonic mucosa (A: H&E stain), reactive to CK7 (B).

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