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.