Report of Two Cases of Colo-rectal Endometriosis

Yasuharu Izumi¹⁾²⁾, Hiroaki Matsunaga¹⁾²⁾, Masaaki Kijiwara¹⁾²⁾, Yoshio Akashi¹⁾, Akira Miyoshi¹⁾

¹⁾Department of Surgery, Chihaya Mutual Aid Hospital
2)First Department of Surgery, Kyushu University

Two cases of colo-rectal endometriosis, which showed different clinical courses, are described. In case 1, the patient complained of melena during her menstrual period. A submucosal tumor was found in the sigmoid colon by fiberscopy and was diagnosed as colonic endometrioma from a biopsy specimen. Hormonal therapy well controlled her symptom. In case 2, the patient complained of severe constipation. A barium enema and fiberscopy revealed marked rectal stenosis which resembled the stenosis of rectal cancer. Though repetitive biopsy did not yield a definitive diagnosis, low anterior resection of the rectum was performed. The resected specimen showed endometrial glands and fibrosis in the entire rectal wall except for the mucosa. In case 1, the symptom was caused by rupture of a submucosal endometrioma into the colon. Therapeutic problem in this type is choice of a better modality whether conservative (hormonal) therapy or the surgical one. In case 2, the symptom was caused by a fibrotic change in the colonic wall which was due to repetitive intramural hemorrhage from the endometrial glands. Therefore, this case was subtyped as diffiese endometriosis. The problem concerned with this type is the differential diagnosis from colo-rectal cancer and the prevention of the over surgery.

Key words
endometrioma, diffuse endometriosis

Reprint requests
Yasuharu Izumi First Department of Surgery, Kyushu University
3-1-1 Maidashi, Higashiku, Fukuoka, 812 JAPAN

Accepted
December 8, 1993

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