1. Patient F/41 CC: Abdominal pain and fever(38.5°C) for 4-5 days Past Hx: G 4 P 1 L 1 D 0 A 1 Appendectomy 10 years ago C/S 7 years ago TAH due to adenomyosis 4 years ago Colonoscopy: 1.5cm sized protruding lesion at 30cm from anal verge Abdominal CT: Extra-luminal abscess, probably secondary to perforating diverticulitis Percutaneous drainage Sigmoidoscopic biopsy

11. ER

12. PR

13. CD 10

16. Colorectal Endometriosis diagnosed by Endoscopic Biopsy Symptom: Pain (acute abdomen), Diarrhea, hematochezia, Stricture/Obstruction, etc. DDx includes Crohn ’ s dis, neoplasm and polyp, mucosal prolapse, ischemic colitis, diverticulitis, PID, pelvic abscess, etc. Serosa and Muscle layer are involved in over 80% of patients with G-I tract endometriosis; Submucosa in 34-66%; and Mucosa in only 10- 30%.(The mucosa is rarely and only focally involved)

17. Colorectal Endometriosis diagnosed by Endoscopic Biopsy Endometriosis affects the intestinal tract in 15% to 37% of patients with pelvic endometriosis. Mucosal changes include ulcer, branching of crypt, crypt abscess, inflammation, pyloric metaplasia, smooth muscle hyperplasia, fissure/fistula, stromal decidual change(3/44), ischemic change, etc. Two out of 5 cases reported in Korea were diagnosed by mucosal biopsy.

18. Colorectal Endometriosis diagnosed by Endoscopic Biopsy Theories of endometriosis: 1) Pelvic implantation of endometrial tissue through fallopian tube 2) Coelomic metaplasia 3) Vascular dissemination of endometrial tissue during menstruation No cases of gastric or esophageal endometriosis have been reported.