Acute Small Bowel Obstruction Secondary to Ileal Endometriosis: Report of a Case

Abstract

We report a case of acute small bowel obstruction occurring secondary to endometriosis of the terminal ileum. Ileal endometriosis is a rare condition that can cause acute small bowel obstruction. As this case and others in the literature highlight, establishing a preoperative diagnosis is very difficult due to the vagueness of symptoms and similarity in presentation to other causes of obstruction, and is based on a high index of suspicion. However, this disorder should be considered in the differential diagnosis of women of child-bearing age who present with symptoms of obstruction. The definitive treatment includes resection of the involved segment with primary anastomosis, and adjuvant hormonal therapy may prevent recurrence.

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

“…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.…”

“…The mucosa is only affected in approximately 10% of previously described cases (2,5,6,13), showing different features such as architectural distortion, chronic inflammatory infiltrate, ulcers, strictures and fistulas, which can be mistaken for Crohn's disease. In the literature search, we found out that a preoperative diagnosis of Crohn's disease was made in 14 case reports (3,6,7,10,14,16), and we similarly initially suspected Crohn's disease in our first case. In some previously reported cases, there was a coexistence of both diseases (16); although the presence of a source of intestinal endometriosis presumably causes a weakness in the affected region of the intestinal wall, in other cases the ischemic and inflammatory events were secondary to endometriosis (2,7,14).…”

“…In the literature search, we found out that a preoperative diagnosis of Crohn's disease was made in 14 case reports (3,6,7,10,14,16), and we similarly initially suspected Crohn's disease in our first case. In some previously reported cases, there was a coexistence of both diseases (16); although the presence of a source of intestinal endometriosis presumably causes a weakness in the affected region of the intestinal wall, in other cases the ischemic and inflammatory events were secondary to endometriosis (2,7,14). This is why the exclusion of the coexistence of the two entities is difficult, if not impossible, in some cases.…”

“…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.…”

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

“…Moreover, only nine of the 29 cases presented clinical signs of small bowel obstruction (6). The most commonly involved mechanisms leading to the apparition of bowel obstruction at this level consist of fibrosis and thickening of the muscular layer (5,7). In rare cases, complete transmural involvement of the digestive wall has been reported, inducing the apparition of intestinal bleeding, bowel intussusception, perforation, perforation or even malignant transformation (8,9).…”