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Patient• F/41• CC: Abdominal pain and fever(38.5°C) for 4-5 days• Past Hx: G4P1L1D0A1
Appendectomy 10 years ago C/S 7 years ago TAH due to adenomyosis 4 years ago• Colonoscopy: 1.5cm sized protruding lesion at 30cm fro
m anal verge • Abdominal CT: Extra-luminal abscess, probably secondar
y to perforating diverticulitis• Percutaneous drainage• Sigmoidoscopic biopsy
ER
PR
CD 10
Colorectal Endometriosisdiagnosed by Endoscopic Biopsy
• Symptom: Pain (acute abdomen), Diarrhea, hematochezia, Stricture/Obstruction, etc.
• DDx includes Crohn’s dis, neoplasm and polyp, mucosal prolapse, ischemic colitis, diverticulitis, PID, pelvic abscess, etc.
• Serosa and Muscle layer are involved in over 80% of patients with G-I tract endometriosis; Submucosa in 34-66%; and Mucosa in only 10-30%.(The mucosa is rarely and only focally involved)
Colorectal Endometriosisdiagnosed by Endoscopic Biopsy
• Endometriosis affects the intestinal tract in 15% to 37% of patients with pelvic endometriosis.
• Mucosal changes include ulcer, branching of crypt, crypt abscess, inflammation, pyloric metaplasia, smooth muscle hyperplasia, fissure/fistula, stromal decidual change(3/44), ischemic change, etc.
• Two out of 5 cases reported in Korea were diagnosed by mucosal biopsy.
Colorectal Endometriosisdiagnosed by Endoscopic Biopsy
• Theories of endometriosis: 1) Pelvic implantation of endometrial tissue through fallopian tube 2) Coelomic metaplasia 3) Vascular dissemination of endometrial tissue during menstruation• No cases of gastric or esophageal endometriosis have be
en reported.