{'fraction_non_alphanumeric': 0.02211166390270868, 'fraction_numerical': 0.01271420674405749, 'mean_word_length': 5.328671328671328, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Sonographic Pitfall in Endometriotic Ovarian Cysts: A Rare Case of a Spontaneous Sigmoid Colonic Perforation in a Nonpregnant Woman

Endometriosis involving the bowel has an estimated prevalence of 8% to 12% in women with endometriosis.1 We report a case of spontaneous sigmoid colonic perforation in a nonpregnant woman with endometriosis. A 42-year-old woman was referred to our institution for lower abdominal pain. She had a history of an ovarian endometrioma, which was laparoscopically treated in 2006. Her cancer antigen 125 level was 296 IU/L, and blood test results were normal. She had neither fever nor signs of bowel obstruction, peritonitis, infection, or vaginal discharge. Transvaginal sonography showed a left ovarian endometrioma (Figure 1, A and B), uterine adenomyosis with absence of the posterior sliding sign, and 2 rectal and sigmoid endometriotic nodules reaching the submucosal layer (Figure 1, C and D). No free fluid in the pouch of Douglas or anterior compartment lesions were noted. Colonoscopy results were negative. Surgical exploration confirmed a frozen pelvis, and purulent fluid appeared when the supposed left ovarian endometrioma was opened. The left ovary was indeed below the pelvic abscess and was macroscopically normal. Surgery resulted in the removal of the periovarian abscess, bilateral salpingectomy, and a rectosigmoid resection with a terminoterminal anastomosis. All of the visible endometriotic pelvic lesions were removed. Cultural swab results for the purulent fluid were positive for group A Streptococcus viridans. The patient was discharged on postoperative day 6 without any complications. Pathologic findings underscored the presence of endometriotic foci surrounding the periovarian abscess and the 2 wall nodules in the rectosigmoid specimen (15 cm).