A Case of Uterine Adenosarcoma and Colonic Endometriosis Masquerading as Inflammatory Bowel Disease.

Background: Endometriosis is a prevalent gynecological condition that primarily affects women of reproductive age. When the gastrointestinal system is involved, it can lead to bowel dysfunction and pose diagnostic challenges.

Aims: To present a rare case of gastrointestinal endometriosis with concurrent uterine adenosarcoma, highlighting the diagnostic complexities and therapeutic considerations.

Methods: A 42-year-old female presented with refractory bloody diarrhea, abdominal pain, and significant unintentional weight loss for several months. Initial investigations, including stool studies and inflammatory markers, ruled out infectious and common inflammatory causes. Endoscopic evaluation revealed multiple polypoid lesions, prompting further imaging. Magnetic resonance enterography (MRE) identified a uterine mass with suspected extrauterine involvement and a rectal nodule, raising concerns for malignancy or extensive gastrointestinal endometriosis. The patient underwent surgical management, including total hysterectomy, bilateral salpingo-oophorectomy, and lower anterior resection.

Results: Histopathological analysis confirmed the coexistence of uterine adenosarcoma and rectal endometriosis. The patient fully recovered after surgery without complications. At her 12-month follow-up, she remained asymptomatic, with no evidence of recurrence or residual disease.

Conclusions: This case underscores the diagnostic and therapeutic challenges of gastrointestinal endometriosis, particularly in the presence of coexisting malignancy. A multidisciplinary approach is essential for early recognition and prompt intervention, which are crucial for improving patient outcomes and quality of life.