Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Rectal Endometriosis That Is Difficult to Differentiate from Endoscopically Resectable Subepitherial Lesion

내시경적 제거가 가능한 직장 점막하 병변으로 오인한 자궁내막증 1예

  • Chung, Seung-Kyu (Department of Internal Medecine, Cheonan Hospital, Soonchunhyang University College of Medicine) ;
  • Lee, Suck-Ho (Department of Internal Medecine, Cheonan Hospital, Soonchunhyang University College of Medicine) ;
  • Son, Bum-Suk (Department of Internal Medecine, Cheonan Hospital, Soonchunhyang University College of Medicine) ;
  • Lee, Chang-Kyun (Department of Internal Medecine, Cheonan Hospital, Soonchunhyang University College of Medicine) ;
  • Lee, Tae-Hoon (Department of Internal Medecine, Cheonan Hospital, Soonchunhyang University College of Medicine) ;
  • Chung, Il-Kwun (Department of Internal Medecine, Cheonan Hospital, Soonchunhyang University College of Medicine) ;
  • Kim, Sun-Joo (Department of Internal Medecine, Cheonan Hospital, Soonchunhyang University College of Medicine) ;
  • Lee, Ji-Hye (Department of Pathology, Cheonan Hospital, Soonchunhyang University College of Medicine)
  • 정승규 (순천향대학교 의과대학 천안병원 내과학교실) ;
  • 이석호 (순천향대학교 의과대학 천안병원 내과학교실) ;
  • 손범석 (순천향대학교 의과대학 천안병원 내과학교실) ;
  • 이창균 (순천향대학교 의과대학 천안병원 내과학교실) ;
  • 이태훈 (순천향대학교 의과대학 천안병원 내과학교실) ;
  • 정일권 (순천향대학교 의과대학 천안병원 내과학교실) ;
  • 김선주 (순천향대학교 의과대학 천안병원 내과학교실) ;
  • 이지혜 (순천향대학교 의과대학 천안병원 병리학교실)
  • Received : 2010.04.14
  • Accepted : 2010.08.07
  • Published : 2010.11.30
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Abstract

Endometriosis occurs most frequently in the intestine. In the pelvic organs intestinal endometriosis presents with various symptoms and endoscopic findings. If an asymptomatic submucosal lesion is found in the sigmoid colon or rectum of reproductive women, a differential diagnosis should be done. Owing to advancements in endoscopic therapy, endoscopic excision has been attempted for various subepithelial lesions. To successfully do an endoscopic excision, accurate diagnosis should be obtained through diagnostic tests such as endoscopic ultrasonography prior to excision. Here the authors report a case of rectal endometriosis in an asymptomatic woman of reproductive age. They attempted endoscopic resection based on the endoscopic finding that the subepithelial lesion was limited to the submucosal layer in endoscopic ultrasonography. This conclusion turned out to be a mistaken one. Because of tumor adhesion to the proper muscular layer, we failed to successfully conduct an endoscopic excision. Ultimately, we did surgery and diagnosed rectal endometriosis.

장관에 발생하는 자궁내막증은 골반내 장기를 제외하면 가장 호발하는 부위이며 다양한 양상의 내시경 소견 및 증상을 보인다. 특히 가임기의 여성에서 구불결장 혹은 직장에서 무증상의 점막하 병변이 발견되었을 때는 감별진단에 포함시켜야 한다. 내시경적 치료술의 발전으로 다양한 점막하 병변에 대한 내시경적 절제가 시도되고 있다. 하지만 실패없는 내시경적 절제를 위해서는 시술전 내시경 초음파 등의 진단적 검사를 통하여 정확한 정보를 얻어야 한다. 저자들은 가임기 여성에서 별다른 증상 없이 내시경으로 발견한 점막하 병변을 내시경 초음파에서 점막하층에 국한된 것으로 오인하여 내시경적 점막하절제술을 시도하였으나 종괴의 고유근육층 유착으로 실패 후 수술적 절제로 자궁내막증으로 최종 진단된 1예를 문헌 고찰과 함께 보고한다.

Keywords

References

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