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Pelvic endometriosis is one of the most common benign gynecological disorders, affecting 5-10% of menstruating women. Intestinal involvement occurs in 3-37% of patients and usually affects the rectosigmoid colon. Colonic endometrial lesions commonly affect only the serosa, and the majority of patients are asymptomatic. Besides, only the serosa and the muscularis propria are usually involved, while the mucosa is very rarely affected. Here we present a rare case of rectosigmoid endometriosis with mucosal invasion which caused abdominal pain, recurrent bloody feces, and mimicked carcinoma of the rectosigmoid on endoscopy. Biopsy proved the diagnosis of endometriosis. The patient underwent anterior resection due to recurrent symptoms and recovered uneventfully. This case demonstrates the propensity of intestinal endometrosis to mimic colon cancer on endoscopic examination. Tissue should be obtained from these patients for histologic study before definitive therapy is decided.