eP250 - Multifocal Intestinal Endometriosis Masquerading as Obstructing Crohn’s Disease

Purpose/Background: The right lower quadrant of the abdomen (RLQ) is host to a myriad of pathologies and accurate definitive diagnosis is often challenging. In premenopausal women, the diagnostic possibilities are more numerous and the overlap between disease processes is even greater. Endometriosis is a traditionally gynecologic pathology that impacts at least 10% of premenopausal women globally. Intestinal endometriosis is an uncommon subtype comprising 3-37% of endometriosis cases and is most often misdiagnosed as a potential gastrointestinal or gynecologic malignancy. As >90% of intestinal endometriosis cases involve the sigmoid colon and rectum, it is an important pathology for colorectal surgeons to consider when evaluating young females in clinic with vague pelvic symptomatology.

We present a case of a 42-year-old female suffering from RLQ pain and recurrent obstructive symptomatology. She underwent extensive work-up, including CT and MR enterography, which demonstrated three areas of inflammation and stenosis concerning for inflammatory bowel disease (IBD). Complete endoscopic evaluation was unsuccessful due to an extrinsic sigmoid lesion but there was no evidence of typical IBD features. Based on imaging findings, she was diagnosed with fibrostenosing Crohn’s and initially was managed with steroids and nutritional optimization as a bridge to elective resection. She ultimately underwent a single-incision laparoscopic ileocolic resection, and a laparoscopic converted to open sigmoidectomy, which demonstrated multifocal intestinal endometriosis involving three synchronous lesions.

There are few reports of multifocal intestinal endometriosis initially diagnosed as IBD reported in the literature. Of these cases, only one other reports three sites of disease and in that case the patient proceeded emergently to surgery and necessitated fecal diversion. Our case highlights the importance of considering the diagnosis of intestinal endometriosis when premenopausal women present with synchronous right and left-sided obstructive lesions concerning for IBD without otherwise impressive laboratory findings or obvious stigmata of IBD on endoscopy. More research is needed to establish evidence-based guidelines for evaluating and diagnosing intestinal endometriosis to help decrease the unnecessary use of steroids, immunologics, and emergency surgical intervention.Methods/Interventions: N/AResults/Outcomes: N/AConclusion/

Discussion: N/AIleocolic Resection Gross SpecimenGross Specimen demonstrating multiple deposits of endometriosis.