Deep colorectal endometriosis is not a frequent disorder, and only 56 cases have been reported in Japan. It is very difficult to make its preoperative diagnosis, because the patients primarily suffer from bowel disturbances. In this paper we reported 3 cases of deep colorectal endometriosis, which had been diagnosed preoperatively as a colorectal cancer associated with bowel symptoms.
Cases 1, 2 and 3 were aged in 45, 32 and 44 years old, respectively, and had no gynecological symptom. They were admitted to the hospital with bowel symptoms such as constipation, nausea, vomiting, diarrhea or melena. Objective findings by barium enema and endoscopy revealed the elevated lesions and narrowings in the rectum in Cases 1 and 2, and in the sigmoid colon in Case3. Pathological findings of the specimens biopsied under a endoscopy showed chronic inflammation with fibrosis, and no evidence of endometriosis and malignancy in all cases.
The patients were laparotomized as a colorectal cancer, as clinically suspected of malignancy. Laparotomic findings showed a firm tumor in the rectum in Cases 1 and 2, and in the sigmoid colon in case 3. Pathological diagnoses were rectal endometriosis in Cases 1 and 2, and endometriosis in sigmaid colon in Case 3, containing endometrial glands and stromal tissues in all 3 cases.
Deep colorectal endometriosis is often diagnosed clinically as a colorectal cancer. To avoid a overtreatment, it is important to make its precise diagnosis preoperatively. Characteristically, bowel symptoms were reported to augment in deep colorectal endometriosis in the menstrual phase. Actually, retrospective data showed that melena had begun just prior to the menstruation in Case 2. This report suggests that the biopsy under a endoscopy should be carried out in the menstrual phase to make a precise diagnosis of deep colorectal endometriosis.
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