Coexistence of endometriosis and inflammatory bowel disease: a case series and practical diagnostic review.

OBJECTIVES

The objective of this review is to identify key clinical lessons and highlight diagnostic and therapeutic strategies derived from case reports and recent literature. Particular attention is given to recognising overlapping presentations, optimising multimodal imaging and endoscopic evaluation, and promoting multidisciplinary collaboration between gastroenterologists, gynaecologists, radiologists, and pathologists to enhance diagnostic accuracy and guide patient-centred management.

METHODS

A case series was conducted at Hospital Universitari Germans Trias i Pujol (2019-2024), including patients with confirmed inflammatory bowel disease and histologically or radiologically verified endometriosis. A literature review was performed using PubMed and Scopus databases (1990-2024) with search terms: "endometriosis," "inflammatory bowel disease," "Crohn's disease," "ulcerative colitis," "diagnosis," and "multidisciplinary management.

CASE PRESENTATION: Case one involved a 35-year-old pregnant woman with Crohn's disease presenting acute abdominal pain initially considered as appendiceal plastron; endometriosis was subsequently confirmed postpartum following laparoscopic appendectomy. Case two concerned a 68-year-old woman with Crohn's disease and rectovesical fistula complications, where histopathological analysis of resected sigmoid tissue revealed concurrent deep infiltrating endometriosis. Case three presented a 36-year-old woman with ileal Crohn's disease experiencing persistent pelvic pain initially misattributed to inflammatory bowel pathology before definitive endometriosis diagnosis. Case four involved a 43-year-old woman with Crohn's disease and axial spondylitis, whose chronic pelvic symptoms were ultimately attributed to deep infiltrating endometriosis.

CONCLUSIONS

The coexistence of endometriosis and IBD presents significant diagnostic and therapeutic challenges requiring multidisciplinary evaluation. Early recognition and targeted imaging strategies are fundamental for preventing delayed diagnoses and optimising patient outcomes.