A Case of Rectal Endometriosis Misdiagnosed as Rectal Malignancy on Three Colonoscopies and Biopsies Sharing a Combined Literature Review

Figures & data

Figure 1 Defecography image.

Figure 2 First colonoscopy image.

Figure 3 Pathological examination of the first colonoscopy biopsy.

Figure 4 Pathological examination of the second colonoscopy biopsy.

Figure 5 Pathological examination of the third colonoscopy biopsy.

Figure 6 Surgical removal of some intestinal tissue samples.

Figure 7 Histopathological analysis following partial intestinal resection.

Figure 8 Immunohistochemical investigation subsequent to partial intestinal resection.

Table 1 Selected Extra-Pelvic Specific Sites of Endometriosis

Case	Age	Involved Site	Symptom	Therapy Method
Heijink T. 2020^Citation14	31	The bartholin gland	Cyclical vulvar pain	Surgical excision
Oner A. 2006^Citation15	28	Nasolacrimal	A cyclical bleeding from puncta of the eyes	No
Pascoal E.2021^Citation16	39	In the medial left thigh, inferior to the pubic ramus, near the gracilis muscle	Catamenialpain	Surgical excision
Aboujaoude N.2021^Citation17	34	Pulmonary	Cyclic hemoptysis	A GnRH agonist
Sherif AM.2016^Citation18	44	Subcapsular hepatic	Progressive right upper quadrant pain and vomiting	Surgery
Heinz Bacher, M.D^Citation19	24	The external anal sphincter	The perianal pain to her menses	Surgery
Yokota N. 2008^Citation20	37	Cervical	A severe vaginal hemorrhage	Uterine artery embolization, The hemorrhage could not be stemmed by wound suture and vaginal tamponade.
Wolthuis AM.2016^Citation21	28	Diaphragmatic	Catamenial right hypochondrium and right shoulder-pain	Surgical excision
Christable E.2021^Citation22	26	Endometriosis of para- aortic	Lower abdominal pain	Surgery
Nigam A. 2013^Citation23	32	In the lower abdominal wall in the region of the caesarean scar in the lateral part.	Cause of deep dyspareunia	Surgery
Newme K.2021^Citation24	42	Umbilical	Blood coming from umbilicus and had a history of dysmenorrhea	Followed-up in outpatient department for 3 years, Symptoms improved after menopause
Charpentier E. 2018^Citation25	42	Pericardial	Unexplained chronic and catamenial chest pain	Nomegestrol
Patel VC.1982^Citation26		Knee	Painful swelling on the lateral aspect of the right knee	Danazol
Yang Y. 2021^Citation27	48	Renal	Intermittent gross hematuria	Mimicking Cystic Renal Tumor and Surgical removal of mass

Table 2 Some Reported Sites, Symptoms and Treatment Modalities of Intestinal Endometriosis

Case	Age	Involved Site	Symptom	Therapy Method	Has a Previous Diagnosis of Endometriosis Been Made
Buldanlı MZ.2020^Citation34	40	Sigmoid colon	Intestinal obstruction	Resected totally respect to oncological principles. And do colostomy.	No
Gregorić P. 2012^Citation35	41	Distal Ileal	Intestinal obstruction	Ileum Resection, and a termino-ter-mino EE anastomosis	Yes
Yilmaz B. 2014^Citation36	42	Sigmoid colon	Rectal bleeding	Segmental resection of the sigmoid colon with side-to-side anastomosis was performed	No
Indraccolo U. 2010^Citation37	36	Cecal	Ileocolic Intussusception	Laparoscopic debulking of the endometriosis, and right hemicolectomy	Yes
Marklund A. 2019^Citation38	30	Rectosigmoid colon	2 weeks interval abdominal pain and a 4 days’ history of obstipation	Neoadjuvant treatment that included radiotherapy and chemotherapy, later do rectum and a bilateral salpingo-oophorectomy	No
Alvarado LER.2021^Citation39	41	Rectal	Complete large bowel obstruction complicated by sepsis and toxic megacolon	Total colectomy with ileostomy	No
Allan Z. 2018^Citation40	37	Large bowel	Large bowel obstruction	Laparoscopic wedge resection of rectosigmoid tumour with primary anastomo-sis and endoscopic decompression	Yes
Garg NK.2009^Citation41	44	Colon	Colonic perforation	A proximal colostomy was performed and the endometriotic mass resected	Yes
Lee M. 2021^Citation42	35	At the cecum near the appendiceal orifice	Fetal demise and gastrointestinal hemorrhage	Symptomatic treatment such as blood transfusion and have a colonoscopy after delivery	No
Aragone L. 2023^Citation43	39	Appendiceal	A week of abdominal pain was diagnosed as appendicitis	Appendectomy	No
Alabbas H. 2019^Citation44	Reports not prompted	Small Bowel	Recurrent semi-obstructive symptoms	Right hemicolectomy	Ovarian cysts were removed but the article did not mention if it was endo
Mittelstadt S. 2022^Citation45	28	The sigmoid colon	Sigmoid perforation	An exploratory laparotomy with c-section. And a partial sigmoid resection with side-to-side anastomosis was performed	No
Nishikawa A. 2013^Citation46	38	Ileum	Ileal perforation and massive intestinal haemorrhage	33+5 underwent cesarean section with Right hemicolectomy and terminal ileum resection	Yes

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