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A 42 year old woman, gravida 3 para 2, was referred to our outpatient clinic for abdominal pain, bloody diarrhoea, and sideropenic anaemia (haemoglobin 9.9 g/dl, iron 40 μg/dl; ferritin 3 ng/dl). Eight months earlier she had underwent colonoscopy. A polyp in the sigmoid colon had been found and removed by hot snare polypectomy. Histological examination had showed the presence of endometriotic foci. After polypectomy, symptoms disappeared. She had never complained of dysmenorrhoea or dyspareunia, symptoms often associated with endometriosis.
Six months later symptoms recurred. We performed colonoscopy twice, during menses and in the intermenstrual period (figs 1, 2, respectively). Colonoscopies showed a polypoid lesion at the same site of the previous polypectomy.
What do these endoscopic images suggest and how would you manage this patient?
See page 1019 for answer
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