Acute small bowel obstruction secondary to intestinal endometriosis, an elusive condition: a case report

Abstract

BackgroundEndometriosis is a benign condition affecting females of reproductive age. Although intestinal endometriosis is common it is rare for the condition to manifest as an acute bowel obstruction secondary to ileocaecal and appendicular endometriosis. This case is important to report as it highlights the diagnostic difficulty this particular condition presents to an emergency surgeon.Case presentationWe present the case of a 33 year old female of Asian origin who presented with symptoms and signs of an acute small bowel obstruction. A right hemicolectomy for suspected malignancy was performed with an ileocolic anastomosis. Histological examination demonstrated extensive endometriosis of the appendix and ileocaecal junction.ConclusionEnteric endometriosis should be considered as a differential diagnosis when assessing females of reproductive age with acute small bowel obstruction. A high index of suspicion is required to arrive at a diagnosis of this elusive condition.

Acute Small Bowel Obstruction and Small Bowel Perforation as a Clinical Debut of Intestinal Endometriosis: A Report of Four Cases and Review of the Literature

“…Fibrosis is a quite common finding associated with endometriosis. Among the previous reported cases in the literature, we found a fibrous mass infiltrating the small bowel and causing an extrinsic obstruction, as well as a fibrous mass in the rectum (11), a mass arising from the appendix (1,14), a hard mass with no clear origin site (12) and an inflammatory plastron involving the uterus, terminal ileum and sigma (3). Potential clinical diagnoses include carcinoid, adenocarcinoma, lymphoma, sarcoma, gastrointestinal stromal tumor or tumors in the vicinity that can comprise the bowel lumen.…”

“…Endometriosis has a predilection to obstruct the terminal ileum. We identify 12 case reports of acute small bowel obstruction in the literature (1,3,6,7,9,(11)(12)(13)(14). Our report describes two additional cases.…”

“…It is estimated to affect 4-17% of menstruating women (1). It typically presents as foci of endometrial glands and stroma outside its anatomical sight in pelvic organs, such as the ovaries, peritoneal cavity of the pelvis and rectovaginal septum.…”

Stromal Endometriosis of the Intestine: An Elusive Presentation with A Review of the Literature: A Case Report

“…The most common symptom of enteric endometriosis is colicky abdominal pain with other common symptoms such as nausea, vomiting, pyrexia, constipation, weight loss and anorexia, which often have a low diagnostic validity [7,8].…”

Ileocecal Obstruction Due to Endometriosis – A Case Report and Literature Review

“…This pathological finding has a peak incidence in the third and fourth decade of age, and is characterized by the presence of extrauterine endometrial tissue (2,3). The most widely recognized theory is the one of retrograde menstruation, leading to the serosal intraperitoneal implantation of the cellular islets (3,4). These lesions will induce local inflammation and fibrosis, inducing the development of adherences with the surrounding pelvic viscera.…”