title: Symptomatic large bowel endometriosis in a woman with a hormonal intrauterine device: a case report.
abstract: BACKGROUND
  Extragenital endometriosis can occur in the rectum and sigmoid causing cyclic rectal bleeding. A hormonal intrauterine device (IUD) (20 microg/24 h levonorgestrel releasing), originally developed as an easily reversible contraceptive method, is a therapeutic option for bleeding disorders.
  
  
  METHODS
  A 34-year-old woman using depot progesterone injection (crys-talline suspension of 150 mg medroxyprogesterone acetate) for contraception was amenorrheic and asymptomatic. After switching to a levonorgestrel-releasing IUD the patient experienced irregular bleeding with concomitant dysmenorrhea and rectal bleeding. Colonoscopy revealed a sigmoid mass. Laparotomy with resection of the sigmoidal mass and ovarian cyst was performed. Histopathologic analysis confirmed the suspected diagnosis of large bowel endometriosis.
  
  
  CONCLUSIONS
  In our patient, large bowel endometriosis became symptomatic 2 years after insertion of hormonal IUD. The suppressive effect of the hormonal IUD seemed to be insufficient for the control of extragenital endometriosis.
authors.affiliation: Department of Obstetrics and Gynecology, Landesklinikum Thermenregion Mödling, Austria. susanne.hinterholzer@gmail.com
authors.forename: Susanne
authors.initials: S
authors.lastname: Hinterholzer
authors.forename: Dominik
authors.initials: D
authors.lastname: Riss
authors.forename: Hermann
authors.initials: H
authors.lastname: Brustmann
mesh_terms: D000328:Adult; D004412:Dysmenorrhea / Q000517:prevention & control; D004715:Endometriosis / Q000188:drug therapy* / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy / Q000601:surgery; D006801:Humans; D007420:Intestine, Large / Q000473:pathology* / Q000601:surgery; D007436:Intrauterine Devices, Medicated; D010048:Ovarian Cysts / Q000188:drug therapy / Q000601:surgery; D012002:Rectal Diseases / Q000188:drug therapy / Q000601:surgery; D016896:Treatment Outcome