Colonoscopic tattoo dye spillage mimics endometriosis on laparoscopy

J Minim Invasive Gynecol. 2014 Jul-Aug;21(4):704-7. doi: 10.1016/j.jmig.2014.01.017. Epub 2014 Jan 25.


Rare adverse effects of India ink injection spillage during colonoscopy have been reported. We present a case report in which prior colonoscopic India ink tattooing was found to mimic intraperitoneal endometriosis in a 48 year-old woman undergoing laparoscopic sterilization. Multiple black lesions suspicious for endometriosis involving the anterior and posterior cul-de-sac, left ovary, and omentum were found. A pathological assessment showed peritoneal tissue with focal dark pigment associated with mild chronic inflammation and deposition of tattoo pigment; there was no evidence of endometriosis in the specimens. Surgical recognition of tattoo ink spillage in the peritoneum is very important to prevent misinterpretation of peritoneal findings.

Keywords: Colonoscopic tattooing; Endometriosis; Laparoscopy.

Publication types

  • Case Reports

MeSH terms

  • Carbon / adverse effects*
  • Coloring Agents / adverse effects*
  • Diagnosis, Differential
  • Douglas' Pouch / pathology*
  • Endometriosis / diagnosis*
  • Endometriosis / surgery
  • Female
  • Humans
  • Laparoscopy
  • Middle Aged
  • Omentum / pathology
  • Ovary / pathology*
  • Peritoneal Diseases / diagnosis*
  • Peritoneal Diseases / surgery
  • Peritoneum / pathology
  • Sterilization, Tubal
  • Tattooing / adverse effects*


  • Coloring Agents
  • chinese ink
  • Carbon