Scar Endometriosis vs Hemangioma: A Diagnostic Conundrum

Scar endometriosis refers to the presence of endometrial glands and stroma at the site of a scar. Hemangiomas, on the other hand, are benign vascular tumors. In this case report, we unravel the clinical enigma around a patient who presented with a painful mass at the previous cesarean section scar site. Initially, we were confident that this was ectopic endometrium presenting as scar endometriosis. However, our journey took an unexpected turn when histopathological findings contradicted our clinical suspicions. Here, we delve into the intricate details of this captivating case, shedding light on the complexities of the diagnosis we faced.

Cecal Endometriosis Presenting as Hematochezia in a Postmenopausal Female

Our report highlights the diagnosis of cecal endometriosis as a unique cause of hematochezia in a postmenopausal female. Cecal endometriosis manifesting as intermittent hematochezia and abdominal pain is uncommon but requires prompt clinical diagnosis and management. We report a case of cecal endometriosis causing hematochezia and subsequent syncope, which prompted the patient's admission to the emergency department. In our patient, a diagnosis of cecal endometriosis was made after a colonoscopy, with multiple biopsies confirming the presence of endometrial tissue embedded in the cecum. We aim to bring awareness of cecal endometriosis presenting as hematochezia in a postmenopausal woman with a history of abdominal pain. This case highlights intestinal endometriosis as a differential diagnosis to be considered in women, regardless of age, with intermittent hematochezia and abdominal pain.

Intestinal obstruction secondary to cecal endometriosis

Endometriosis of the gastrointestinal tract is rare and occurs in <1% of all patients undergoing major gynecological surgeries. Bowel involvement has been reported in 3%-37% of all women of childbearing age with endometriosis. Total obstruction of the gastrointestinal tract occurs in <1% of cases of endometriosis with bowel obstruction. This case report is that of a 42-year-old female who presented with a 6-month history of change in bowel habits in favor of increasing constipation. This was associated with cyclical lower abdominal pains, abdominal swelling, and weight loss. Examination revealed hyperactive bowel sounds with scant fecal matter on rectal examination. An impression of intestinal obstruction was made and she had an emergency laparotomy. Dilated ileum and a hard, constricting cecal mass were found intraoperatively. She had a right hemicolectomy and ileo-transverse anastomosis, with progressive improvement postoperatively. Histology of the resected bowel segment confirmed cecal endometriosis. In conclusion, cecal endometriosis is a rare cause of intestinal obstruction. A high index of suspicion is required for diagnosis, especially if the woman is premenopausal with a history of abdominal pain that worsens with menstrual periods. Outcome is good with appropriate surgical intervention.