Colonic endometriosis

Gastrointestinal tract images Colonic endometriosis is discussed here in the tumor section because its appearance often mimics a neoplasm. Endometriosis signifies the presence of functioning endometrial tissue in ectopic sites. The most common site of intestinal involvement is the anterior rectal region, followed by the appendix and ileocecal region. Endometriosis involving the rectovaginal septum posteriorly and then extending laterally into the uterosacral ligaments and anterior rectal wall results in fibrosis and scarring, eventually leading to a colorectal stricture and obstructive symptoms. Perforation and an acute abdomen are rare complications.
This tissue undergoes change under hormonal stimulation. In symptomatic women pain and altered bowel habits are common presentations. Clinically, endometriosis often mimics inflammatory bowel disease. Colonoscopy reveals intact mucosa at the site of involvement; mucosal ulcerations occur in a minority and are a cause of rectal bleeding. At times only laparoscopy establishes the diagnosis. With typical anterior rectal wall involvement, barium enema findings are similar to those seen with rectal invasion by a gynecologic tumor or metastasis to the pouch of Douglas.
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This is radiology images of A,B: Two women with rectal endometriosis (arrows) identified on lateral barium enema views. The focal, corrugated, anterior rectal wall involvement is typical. A gynecologic cancer growing posteriorly into the rectal serosa has a similar appearance.

Endorectal US achieved a sensitivity and specificity of over 95% in detecting rectovaginal septal infiltration by endometriosis. Although these results are impressive, the role of US in providing a differential diagnosis and aiding management is not clear. Magnetic resonance imaging reveals endometriosis >1 cm in size to be homogeneously hyperintense on T1-weighted images and hypointense on T2-weighted images; smaller lesions tend toward a variable T2- weighted signal. Some foci contain a cystic component. Surgery for rectosigmoid endometriosis is technically difficult. At times posterior vaginal wall excision and partial rectal resection are necessary.
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Radiology images Endometriosis involving pouch of Douglas. Sagittal (A) and transverse (B) T2–weighted magnetic resonance (MR) images reveal a heterogeneous tumor between the uterus and rectum (arrows), illustrating how the anterior rectal wall is so often involved.
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