Small bowel obstruction due to subserosal endometriosis: an elusive condition

Authors

  • Garima Mishra Department of Obstetrics and Gynaecology, Mahatma Gandhi Memorial Medical College, Indore, MP, India
  • Manu Vats Department of General Surgery, Lady Hardinge Medical College, New Delhi, India
  • Diwakar Pandey Department of General Surgery, Lady Hardinge Medical College, New Delhi, India
  • Azaz Akhtar Department of General Surgery, Lady Hardinge Medical College, New Delhi, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20160610

Keywords:

Endometriosis, Small bowel, Small bowel obstruction

Abstract

The bowel is involved in 3.8 to 37% of women with endometriosis, out of which nearly 1% present with signs of bowel obstruction to the surgeon. This report describes a case of acute small bowel obstruction in a 23 years old woman. The patient gave a history of intermittent episodes of pain abdomen and abdominal distension for the past 1 year with significant loss of weight. The menstrual cycles were normal. Although there was no history of Tuberculosis, a positive history of contact was present. The clinical and biochemical picture was suggestive of peritonitis. CECT of the abdomen revealed a long segment distal ileal stricture. With a provisional diagnosis of Tubercular Ileo-Caecal stricture perforation, a midline exploratory laparotomy was performed. The procedure consisted of right limited hemicolectomy and primary ileo-ascending anastomosis with a proximal loop ileostomy. Ileostomy was done to allow the healing of distal anastomosis and closure was done after 4 weeks. Histopathology of the resected segment of ileum revealed subserosal endometriosis. Postoperatively, the patient was not given any hormonal therapy and recovery has been uneventful over the past 1 year of follow up.

References

Zimmermann EM, Christman GM. Approach to the female patient with gastrointestinal disease. In: T Yamada, DH Alpers, C Owyang, DW Powell, FE Silverstein, eds. Textbook of Gastroenterology. Philedelphia, Pa, USA: Lippincott. 1995:1023-43.

Buanga KJ, Alcazar JL, Laparte MC. Catamenial rectal bleeding and sigmoid endometriosis. J Gynecol Obstet Biol Reprod (Paris). 1992;21:773-4.

Beltran MA, Tapia QTF, Araos HF, Martinez GH, Cruces KS. Ileal endometriosis as a cause of intestinal obstruction: Report of two cases. Rev Med Chil. 2006;134:485-90.

Bulun SE. Endometriosis. N Engl J Med. 2009;360:268-79.

Bergqvist A. Different types of extragenital endometriosis: a review. Gynecol Endocrinol. 1993;7:207-21.

Duepree HJ, Senagore AJ, Delaney CP, Marcello CP, Brady KM, Falcone T. Laparoscopic resection of deep pelvic endometriosis with rectosigmoid Involvement. J Am Coll Surg. 2002;195:754-8.

Yantiss RK, Clement PB, Young RH. Endometriosis of the intestinal tract: a study of 44 cases of a disease that may cause diverse challenges in clinical and pathologic evaluation. Am J Surg Pathol. 2001;25:445-54.

Varras M, Kostopanagiotou E, Katis K, Farantos CH, Angelidou-Manika Z, Antoniou S. Endometriosis causing extensive intestinal obstruction simulating carcinoma of the sigmoid colon: a case report and review of the literature. Eur J Gynaecol Oncol. 2002;23:353-7.

Won KH. Endometriosis, mucocele, and regional enteritis of Meckel’s diverticulum: An unusual case report and experiences in 111 cases. Archives of Surgery. 1969;98(2):209-12.

Bergemann W, Heuer C. Extragenital endometriosis with multiple stenoses of the small intestine. Fortschritte der Medizin. 1992;110(15):281-4.

Witz CA. Current concepts in the pathogenesis of endometriosis. Clinical Obstetrics and Gynecology. 1999;42(3):566-85.

Minh HN, Smadja A, Orcel L. An integrated histogenetic concept of internal and external endometriosis. Journal de Gyn´ecologie, Obst´etrique et Biologie de la Reproduction. 1986;15(1):29-35.

Quinn M. Endometriosis: the consequence of neurological dysfunction. Medical Hypotheses. 2004;63(4):602-08.

Ouinn MJ. Endometriosis: The consequence of uterinedenervation—reinnervation. Archives of Gynecology and Obstetrics. 2011;284:1423-9.

Donnez J, Spada F, Squifflet J, Nisolle M. Bladder endometriosis must be considered as bladder adenomyosis. Fertil Steril. 2000;74:1175-81.

Anaf V, Nakadi IE, Simon P. Preferential infiltration of large bowel endometriosis along the nerves of the colon. Human Reproduction. 2004;19(4):996-1002.

Langlois NE, Park KG, Keenan RA. Mucosal changes in the large bowel with endometriosis: a possible cause of misdiagnosis of colitis. Hum Path. 1994;25:1030-4.

Agic A, Xu H, Finas D. Is endometriosis associated with systemic subclinical inflammation?. Gynecol Obstet Invest. 2006;62:139-47.

Bazot M, Darai E, Hourani R, Thomassin I, Cortez A, Uzan S, et al. Deep pelvic endometriosis: MR imaging for diagnosis and prediction of extension of disease. Radiology. 2004;232:379-89.

Loubeyre P, Petignat P, Jacob S, Egger JF, Dubuisson JB, Wenger JM. Anatomic distribution of posterior deeply infiltrating endometriosis on MRI after vaginal and rectal gel opacification. AJR Am J Roentgenol. 2009;192:1625-31.

Biscaldi E, Ferrero S, Fulcheri E, Ragni N, Remorgida V, Rollandi GA. Multislice CT enteroclysis in the diagnosis of bowel endometriosis.Eur Radiol. 2007;17:211-9.

Teke Z, Aytekin FO, Atalay AO, Demirkan NC. Crohn’s disease complicated by multiple stenoses and internal fistulas mimicking small bowel endometriosis. World Journal of Gastroenterology. 2008;14(1):146-51.

Kavallaris A, Köhler C, Kühne-Heid R, Schneider A. Histopathological extent of rectal invasion by rectovaginal endometriosis. Hum Reprod. 2003;18(6):1323-7.

Bedaiwy MA, Falcone T. Laboratory testing for endometriosis.Clin Chim Acta. 2004;340:41-56.

Mounsey AL, Wilgus A, Slawson DC. Diagnosis and management of endometriosis. Am Fam Physician. 2006;74:594-600.

Ferrero S, Camerini G, Ragni N, Menada MV, Venturini PL, Remorgida V. Triptorelin improves intestinal symptoms among patients with colorectal endometriosis. Int J Gynaecol Obstet. 2010;108:250-1.

Ferrero S, Camerini G, Ragni N, Venturini PL, Biscaldi E, Remorgida V. Norethisterone acetate in the treatment of colorectal endometriosis: a pilot study. Hum Reprod. 2010;25:94-100.

Whelton C, Bhowmick A. Acute endometrial bowel obstruction-A rare indication for colonic stenting. Int J Surg Case Rep. 2013;4:160-3.

Yap C, Furness S, Farquhar C. Pre and post operative medical therapy for endometriosis surgery. Cochrane Database Syst Rev. 2004;3:CD003678.

Biliatis I, Akrivos N, Sotiropoulou M, Rodolakis A, Simou M, Antsaklis A. Endometrial stromal sarcoma arising from endometriosis of the terminal ileum: the role of immunohistochemistry in the differential diagnosis.Journal of Obstetrics and Gynaecology Research. 2012;38(5):899-902.

Downloads

Published

2017-02-23

Issue

Section

Case Reports