Asian Journal of Research and Reports in Gastroenterology

A Distinctly Rare Cause of Haemafecia: Recto-Sigmoid Endometriosis

Shishirendu Parihar

Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.

Aakash Shah

Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.

Nitesh Bassi

Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.

Ishan Mittal

Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.

Chandrika Gupta

Dr. Lal Path Labs, Varanasi, Uttar Pradesh, India.

Anurag K. Tiwari

Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.

Vinod Kumar

Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.

Sunit Shukla

Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.

V. K. Dixit

Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.

D. P. Yadav *

Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.

*Author to whom correspondence should be addressed.

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Abstract

Endometriosis is defined as the growth of functional endometriotic gland and stroma outside the uterine cavity. Although it is common in women of reproductive age (10-12% of menstruating females), extra genital endometriosis is considerably rare. Bowel involvement is estimated to occur in 5%–12% with the recto-sigmoid region involved in up to 90% of these cases. Recto-sigmoid endometriosis may manifest with abdominal pain, constipation, and rectal bleeding. For diagnosis radiological investigations like Transvaginal ultrasound and MRI pelvis are widely used, endoscopic biopsy is less rewarding, however surgically resected specimen provides appropriate tissue for diagnosis. The management consists of hormonal therapy including Oral Contraceptive pills, Gonadotrophin releasing hormone analogue and surgical resection of affected segments. Hence recto sigmoid endometriosis can present as a rare etiology of haematochezia. We present the case of a 25-year-old Caucasian female patient with recto-sigmoid endometriosis.

Keywords: Endometriosis, haemafecia, lower gastrointestinal bleeding, recto-sigmoid colon, laparoscopic excision

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References

Spaczynski RZ, Duleba AJ. Diagnosis of endometriosis. Semin Reprod Med 2003; 21:193-208.

Berlanda N, Somigliana E, Frattaruolo MP, et al. Surgery versus hormonal therapy for deep endometriosis: Is it a choice of the physician? Eur J Obstet Gynecol Reprod Biol. 2017;209:67-71.

Habib N, Centini G, Lazzeri L, et al. Bowel endometriosis: Current perspectives on diagnosis and treatment. Int J Womens Health. 2020;12:35-47.

Petrucciani N, Socciarelli F, Di Cesare T, et al. Intestinal endometriosis: A sigmoid mass mimicking a colic neoplasm. Am Surg. 2012;78(9):383-384.

González-Pezzat I, Soto-Pérez-de-Celis E, García-Lascurain JL. Bowel endometriosis as an unusual cause of rectal bleeding. Am Surg. 2011;77(2):239-241.

Wolthuis AM, Meuleman C, Tomassetti C, et al. Bowel endometriosis: Colorectal surgeon's perspective in a multidisciplinary surgical team. World J Gastroenterol. 2014;20(42):15616-15623.

Abrão MS, Petraglia F, Falcone T, et al. Deep endometriosis infiltrating the recto-sigmoid: Critical factors to consider before management. Hum Reprod Update. 2015; 21(3):329-339.

Nisenblat V, Bossuyt PM, Farquhar C, Johnson N, Hull ML. Imaging modalities for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev. 2016;2:CD009591.

Nezhat C, Li A, Falik R, et al. Bowel endometriosis: diagnosis and management. Am J Obstet Gynecol. 2018; 218:549-562.

Kennedy S, Bergqvist A, Chapron C, et al. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod. 2005;20(10):2698-2704.

Vercellini P, Crosignani P, Somigliana E, et al. ‘Waiting for Godot’: A commonsense approach to the medical treatment of endometriosis. Hum Reprod. 2011;26(1): 3-13.

Vercellini P, Buggio L, Somigliana E. Role of medical therapy in the management of deep rectovaginal endometriosis. Fertil Steril. 2017;108(6):913-930.

Alabiso G, Alio L, Arena S, et al. How to manage bowel endometriosis: The ETIC approach. J Minim Invasive Gynecol. 2015; 22(4):517-529.

Vercellini P, Crosignani PG, Somigliana E, et al. Medical treatment for rectovaginal endometriosis: What is the evidence? Hum Reprod. 2009;24(10):2504-2514.

Bachmann R, Bachmann C, Lange J, et al. Surgical outcome of deep infiltrating colorectal endometriosisin a multidisciplinary setting. Arch Gynecol Obstet. 2014;290(5):919-924.

Wattiez A, Puga M, Albornoz J, et al. Surgical strategy in endometriosis. Best Pract Res Clin Obstet Gynaecol. 2013; 27(3):381-392.