P127 Endometriosis presenting as ulcerative colitis – a case report

Introduction

Endometriosis and inflammatory bowel disease have similar presentation features leading to diagnostic challenge and delayed diagnosis

Methods

A 37-year old female presented to the emergency department with a 1 week history of abdominal pain associated with diarrhoea. She had a background of endometriosis and irritable bowel syndrome. Her bloods showed raised CRP of 134 and raised faecal calprotectin. CT scan showed thickening and stricturing of 6–7cm area of terminal ileum and small bowel dilatation measuring 4cm. She then had an MRI small bowel that showed 10cm terminal ileum stricture. She was treated as colitis and commenced on intravenous hydrocortisone. She was discussed at local inflammatory bowel disease (IBD) MDT and decision to commence rescue infliximab was made. She responded well to steroids and infliximab and was discharged with colonoscopy as an outpatient. Her flexible sigmoidoscopy 2 weeks post discharge showed normal colon with no evidence of inflammation and histology showed normal left colon. She had ongoing abdominal pain after discharge and had 2 further infliximab infusions as an outpatient. She represented to emergency department 4 months after her original presentation due to uncontrollable abdominal pain and loss of appetite. She was treated surgically this admission and underwent a laparoscopic right hemicolectomy. Findings on laparoscopy showed terminal ileum stricturing with no evidence of Crohn's disease. Histology taken from terminal ileum showed grade 4 endometriosis within the bowel.

Results

Endometriosis and IBD share similar presentation features that lead to diagnostic uncertainty.¹ 8 published case reports describe patients initially diagnosed as IBD that were laterfound to have intestinal endometriosis after histopathology was obtained via laparoscopy.^2–8 7 of these cases were diagnosed as Crohn's disease^2–8 vs 1 of ulcerative colitis⁹ (UC). Presentation features of these cases varied from abdominal pain, intestinal obstruction and symptoms of colitis. of these patients ileal disease was most common. 6 patients have been reported to have both IBD and endometriosis co-existing.^10–15 2 case reports have been published describing abdominal endometriosis that was later found to be Crohn's disease with no histopathological evidence of endometriosis.^{16 17}

Conclusions

Overlap in presenting features of both endometriosis and inflammatory bowel disease can lead to diagnostic challenge and delayed diagnosis and treatment. Consider abdominal endometriosis in patients presenting with features of IBD and do not respond with steroids and biologics.

References

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