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[GI endometriosis À§Àå°ü Àڱ󻸷Áõ]

1. Introduction

2. ´ëÀå ¿ëÁ¾ ¾ç»óÀÇ Á÷Àå Àڱ󻸷Áõ

3. Wall thickening mass ¾ç»óÀÇ endometriosis

4. More cases


1. Introduction to endometriosis

1) Definition of endometriosis: presence of endometrial glands and stroma outside the endomtrial cavity and uterine musculature

2) Incidence: 8-15%

3) Location of endometriosis : Ovary>broad ligament>cul de sac>uterosacral lig.

4) Bowel involvement
- Incidence : 3-37 % in endometriosis
- Location: rectum & S-colon (40%) >appendix > ileum > cecum
- Depth: serosa & muscularis propria (all) > submucosa (34%) > mucosa (10%)


2. ´ëÀå ¿ëÁ¾ ¾ç»óÀÇ Á÷Àå Àڱ󻸷Áõ (µå¹® ÇüÅÂÀÔ´Ù¸¸ ÇÊÀÚ°¡ óÀ½ °æÇèÇÏ¿´´ø Áõ·ÊÀÔ´Ï´Ù.)

Á¦°¡ óÀ½ °æÇèÇÑ Àڱ󻸷ÁõÀÔ´Ï´Ù. Á÷ÀåÃâÇ÷·Î ³»¿øÇÑ 40´ë ¿©¼ºÀÇ ´ëÀå³»½Ã°æ¿¡¼­ ¸Å¿ì ºÓÀº ¿ëÁ¾À» ¹ß°ßÇÏ°í ¿ëÁ¾ÀýÁ¦¼úÀ» ½ÃÇàÇÏ¿´½À´Ï´Ù. º´¸®°á°ú´Â Àڱ󻸷ÁõÀ̾ú½À´Ï´Ù. ´ç½Ã´Â GnRH agonist (leuproreline 3.75mg monthly IM)¸¦ Åõ¿©ÇÏ¿´°í ´õ ÀÌ»ó ÃâÇ÷Àº ¾ø¾ú½À´Ï´Ù. 2007³â¿¡ ´ëÇѳ»°úÇÐȸÁö¿¡ Áõ·Êº¸°í¸¦ Çß½À´Ï´Ù (¸µÅ©).

Endometriosis with hemorrhagic necrosis

Result of immunostaining: Estrogen receptor (+), Progesterone receptor (+)


3. Wall thickening mass ¾ç»óÀÇ endometriosis

2021³â 5¿ù 13ÀÏ »ï¼º¼­¿ïº´¿ø ¸ñ¿ä³»½Ã°æÁý´ãȸ Áõ·Ê¿´½À´Ï´Ù. Rectal endometriosis Áõ·Ê¿´´Âµ¥ Á¶Á÷°Ë»ç¿¡¼­ È®ÀεǾú´ÂÁö Áú¹®ÀÌ ÀÖ¾ú´Âµ¥ Á¦°¡ ±â¾ï³ªÁú ¾Ê¾Æ¼­ Áý´ãȸ ÈÄ È®ÀÎÇÏ¿´½À´Ï´Ù. ¼ö¼ú Àü °ú°Å Á¶Á÷°Ë»ç¿¡¼­ Ưº°ÇÑ ÀÌ»óÀÌ ¾ø¾ú´Ù°í ÇÕ´Ï´Ù.

40´ë Áß¹Ý ¿©¼ºÀÔ´Ï´Ù. 3³â Àü ´ëÀå³»½Ã°æ¿¡¼­ upper rectumÀÇ º´¼Ò°¡ ¹ß°ßµÇ¾ú°í Á¶Á÷°Ë»ç¿¡¼­ ÀÌ»óÀÌ ¾ø¾î °æ°ú°üÂûÀ» ±ÇÀ¯¹Þ¾Ò½À´Ï´Ù. 1³â ÀüºÎÅÍ º¯ÀÌ Â÷ ÀÖ´Â °Í °°Àº ´À³¦°ú tenesmus°¡ ÀÖ¾î ³»½Ã°æ °Ë»ç¸¦ ´Ù½Ã ¹Þ¾Ò°í anal verge 12-16cm¿¡ 4cm °¡·®ÀÇ diffusely elevated wall thickening mass°¡ º¸¿´À¸¸ç (¾Æ·¡ »çÁø) EUS¿¡¼­ 20x14.3mm sized hypoechoic mass in the proper muscle layer with infiltration to the sumucosal layer ¼Ò°ßÀ̾ú½À´Ï´Ù (EUS »çÁøÀº unavailable). ÀÌ»óÀÇ ¼Ò°ßÀ¸·Î r/o endometriosis, r/o GIST impression ÇÏ¿¡ ¼ö¼úÀ» ±ÇÀ¯¹Þ°í ÀǷڵǼ̽À´Ï´Ù.

³»½Ã°æÀ¸·Î º´¼Ò Á÷ÇϺο¡ tattooining ÇÑ ÈÄ segmental resection ½ÃÇàÇÏ¿© endometriosis¸¦ È®ÀÎÇÏ¿´½À´Ï´Ù.


4. More cases

¹«Áõ»ó °ËÁø³»½Ã°æ

Rectal bleeding during mestruation period

°Ç°­°ËÁø¿¡¼­ ¹ß°ßµÈ cecal massÀÔ´Ï´Ù. CT¿¡¼­ ¾à 2 cm Å©±âÀÇ oval enhancing mass°¡ cecal base¿¡¼­ ¹ß°ßµÇ¾ú°í GISTÀÇ °¡´É¼ºÀÌ ÀÖ´Â °ÍÀ¸·Î Æò°¡µÇ¾ú½À´Ï´Ù. ±×¸®°í ¿ì¿¬È÷ ovary¿Í salpinx¿¡¼­ cyst mass°¡ ¹ß°ßµÇ¾î joint operationÀ¸·Î salpingo-oophorectomy¿Í cecectomy¸¦ ½ÃÇàÇÏ¿´½À´Ï´Ù. °á°ú´Â ¸ðµÎ endometriosis¿´½À´Ï´Ù.

»ý¸®Áֱ⿡ ¹èº¯ ½Ã ÅëÁõÀÌ ÀÖ°í ÁúÃâÇ÷µµ ´Ã¾úÀ½ (¸ñ¿äÁ¡½ÉÁý´ãȸ 20160602)

ObstructionÀ¸·Î stent±îÁö ÇÏ¿´´ø endometriosis

Àڱ󻸷ÁõÀ¸·Î 5³â Àü ¼ö¼úÀ» ¹ÞÀ¸¼Ì´ø ºÐÀÇ IDA. CT¿¡¼­ rectal wall thickening ÀÖ¾î ´ëÀå³»½Ã°æ °Ë»ç ½ÃÇà.

Clinical Endoscopy 2015³â 1¿ùÈ£¿¡ À§Á¡¸·ÇÏÁ¾¾ç ¾ç»óÀÇ endometriosis Áõ·Êº¸°í°¡ ½Ç·È½À´Ï´Ù (¸µÅ©).



© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng.