We report a case of intestinal endometriosis in which polypoid-grown endometrial tissues from the pouch of Douglas penetrated the rectal wall.
A 35-year-old single female visited the hospital with the chief complaints of low abdominal pain during menstrual period and bloody stool. Barium enema showed a filling defect of walnut size and with irregular surface at the rectum. Endoscopic findings showed a cauliflower-like segmented tumor which was liable to bleed at the anterior wall of rectum. The endometrial tissue was confirmed with biopsy. Hormonal therapy for 5 months resulted in no synptomatic remission. Therefore, the anterior resection of the rectum was excised. The operative findings showed a close adhesion between the uterus and rectum, and a chocolate cyst at the right ovarium. Histological examination showed that endometrial tissue grown from the pouch of Douglas penetrated the rectal wall and protruded into the intestine. In addition, the endometrial tissue was observed at the right ovarium.
Intestinal endometriosis commonly grows in the intestinal wall. It is rare, like this case, that endometriosis presenting polypoid-grown from the pouch of Douglas perforates the rectal wall, and only 2 cases have been reported in Japan.