Normal Endoscopy Does Not Exclude Rectosigmoid Endometriosis: A Diagnostic Pitfall Revealed by Endoscopic Ultrasonography

Authors

Sara HDIYE, Ahlame BENHAMDANE, Tarik ADDAJOU, Fedoua ROUIBAA, Hassan SEDDIK

Journal Information

Journal: Medpeer Publisher

ISSN: 3066-2737

Volume: 3

Issue: 5

Date of Publication: 2026/05/21

DOI: 10.70780/medpeer.000QGSR

Abstract

Intestinal involvement in deep infiltrating endometriosis predominantly affects the rectosigmoid colon and may remain difficult to diagnose because mucosal abnormalities are often absent. We report the case of a 39-year-old woman with a history of diffuse endometriosis who presented with pelvic pain associated with cyclic rectal discharge. Pelvic magnetic resonance imaging suggested infiltration of the rectosigmoid junction. Rectosigmoidoscopy showed no visible abnormality. Radial rectal endoscopic ultrasonography subsequently demonstrated infiltration of the anterior sigmoid wall extending from 15 to 23 cm from the anal verge, involving the muscular layer while preserving the mucosa and the remaining rectal wall structures. Sigmoid endometriosis was diagnosed, and the patient was referred for multidisciplinary management. This case emphasizes the importance of endoscopic ultrasonography in the evaluation of suspected bowel endometriosis when conventional endoscopy is inconclusive.

Keywords

endometriosis, MRI, endoscopic ultrasound, case report