Background/Aims: Endometriosis of the intestinal tract (IE) is thought to mimic inflammatory bowel disease (IBD) both clinically and pathologically but robust data on a large unselected series are missing. Diagnostic problems arise both at colonoscopy as well as on resection specimens for IE when IBD-like features are encountered. The aim was to establish the frequency of IBD-like histology in IE and which type of histological lesions are shared by these two entities. Methods: One hundred consecutive, unselected cases of surgically resected IE were collected and clinical features and histopathology reviewed and reevaluated. Results: Seventy-five surgical specimens showed no histological alterations except for endometriosis foci. Twenty-two cases showed focal architectural alterations in the absence of significant inflammation. Three cases showed marked inflammatory and architectural mucosal changes making a differential diagnosis with IBD particularly challenging. On follow-up, however, these patients remained symptom-free and with no need for anti-inflammatory therapy after surgical resection of IE. Conclusions: Diagnostic problems may arise in women who have IBD-like symptoms and histology at colonoscopy but who lack a known diagnosis of endometriosis. Clinicians must be aware that the diagnosis of IBD in patients with IE should be reevaluated over time.

Keywords:
Colon, Endometriosis, Inflammation, Inflammatory bowel disease
1.
Lakatos PL: Recent trends in the epidemiology of inflammatory bowel diseases: up or down? World J Gastroenterol 2006;12:6102-6108.
2.
Molodecky NA, Soon IS, Rabi DM, Ghali WA, Ferris M, Chernoff G, Benchimol EI, Panaccione R, Ghosh S, Barkema HW, Kaplan GG: Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology 2012;142:46-54.e42.
3.
Chouraki V, Savoye G, Dauchet L, Vernier-Massouille G, Dupas JL, Merle V, Laberenne JE, Salomez JL, Lerebours E, Turck D, Cortot A, Gower-Rousseau C, Colombel JF: The changing pattern of Crohn's disease incidence in northern France: a continuing increase in the 10- to 19-year-old age bracket (1988-2007). Aliment Pharmacol Ther 2011;33:1133-1142.
4.
Shepherd NA: Pathological mimics of chronic inflammatory bowel disease. J Clin Pathol 1991;44:726-733.
5.
Langlois NE, Park KG, Keenan RA: Mucosal changes in the large bowel with endometriosis: a possible cause of misdiagnosis of colitis? Hum Pathol 1994;25:1030-1034.
6.
Parr NJ, Murphy C, Holt S, Zakhour H, Crosbie RB: Endometriosis and the gut. Gut 1988;29:1112-1115.
7.
Jerby BL, Kessler H, Falcone T, Milsom JW: Laparoscopic management of colorectal endometriosis. Surg Endosc 1999;13:1125-1128.
8.
Kavallaris A, Köhler C, Kühne-Heid R, Schneider A: Histopathological extent of rectal invasion by rectovaginal endometriosis. Hum Reprod 2003;18:1323-1327.
9.
Fenoglio-Preiser CM (eds): Gastrointestinal Pathology: An Atlas and Text, ed 3. Philadelphia, Wolters Kluwer/Lippincott Williams & Wilkins, 2008, Chapter 13, pp 878-881.
10.
Kim KJ, Jung SS, Yang SK, Yoon SM, Yang DH, Ye BD, Byeon JS, Myung SJ, Kim JH: Colonoscopic findings and histologic diagnostic yield of colorectal endometriosis. J Clin Gastroenterol 2011;45:536-541.
11.
Rowland R, Langman JM: Endometriosis of the large bowel: a report of 11 cases. Pathology 1989;21:259-265.
12.
Yantiss RK, Clement PB, Young RH: Endometriosis of the intestinal tract: a study of 44 cases of a disease that may cause diverse challenges in clinical and pathologic evaluation. Am J Surg Pathol 2001;25:445-454.
13.
Jiang W, Roma AA, Lai K, Carver P, Xiao SY, Liu X: Endometriosis involving the mucosa of the intestinal tract: a clinicopathologic study of 15 cases. Mod Pathol 2013;26:1270-1278.
14.
Craninx M, D'Haens G, Cokelaere K, Baert F, Penninckx F, D'Hoore A, Ectors N, Rutgeerts P, Geboes K: Crohn's disease and intestinal endometriosis: an intriguing co-existence. Eur J Gastroenterol Hepatol 2000;12:217-221.
15.
Kaemmerer E, Westerkamp M, Kasperk R, Niepmann G, Scherer A, Gassler N: Coincidence of active Crohn's disease and florid endometriosis in the terminal ileum: a case report. World J Gastroenterol 2013;19:4413-4417.
16.
Tong YL, Chen Y, Zhu SY: Ileocecal endometriosis and a diagnosis dilemma: a case report and literature review. World J Gastroenterol 2013;19:3707-3710.
17.
Boulton R, Chawla MH, Poole S, Hodgson HJ, Barrison IG: Ileal endometriosis masquerading as Crohn's ileitis. J Clin Gastroenterol 1997;25:338-342.
18.
Jess T, Frisch M, Jørgensen KT, Pedersen BV, Nielsen NM: Increased risk of inflammatory bowel disease in women with endometriosis: a nationwide Danish cohort study. Gut 2012;61:1279-1283.
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2015
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