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Isolated gastrohepatic sarcoidosis presenting as acute abdominal pain

Introduction: Endometriosis is a relatively frequent disease in fertile women. It has been reported to occur in 3 to 19% of menstruating women. The intestine is involved in 12-37% of cases. The sigmoid colon is the most commonly affected segment, followed by the rectum; these two sites together account for 70% of intestinal cases. We report a unique case of rectal endometriosis mimicking malignant rectal mass. Case: The patient’s chief complaints were diarrhea, hematochezia, and fecal urgency, which had been progressive and present for two years. The rectal mass was diagnosed by her local physician, and mucosal biopsies showed ulceration with dysplasia; worrisome for underlying cancer. At Mayo Clinic, rectal endoscopic ultrasound (EUS) revealed a 15 22 mm infiltrating, echopoor, extrinsic rectal mass extending into the right lateral rectal wall involving the submucosa and muscularis propria. The histology of fine needle aspirate specimen revealed endometriosis. Six months therapy with Lupron diminished the size of the endometriosis, and repeat rectal EUS revealed a 8 16 mm echopoor, rectal mass. She underwent a laparoscopic-assisted low anterior resection for definitive treatment of the severe rectal endometriosis with resolution of symptoms. Conclusion: This case demonstrates the added value of rectal EUS in establishing an accurate diagnosis and facilitating targeted deep rectal biopsies to differentiate intestinal endometriosis from colorectal cancer.