Endometriosis: a rare cause of small bowel obstruction

Abstract

Although endometriosis is a common condition in young women, symptomatic involvement of the small bowel is rare. The authors report the case of a 44-year-old lady initially thought to have irritable bowel syndrome who presented 1 month later with acute small bowel obstruction. A CT scan showed small bowel dilatation with a transition point in the ileum, but no distinct lesion. The patient had an exploratory laparotomy where an obstructing lesion in the terminal ileum and several enlarged mesenteric lymph nodes were identified. Consequently, a right hemicolectomy was performed. Pathology specimens showed multiple endometriotic foci in the bowel with stricturing of terminal ileum and appendiceal intussusception. This likely resulted in subocclusive episodes and intestinal obstruction. This case highlights the difficulty in establishing a preoperative diagnosis of endometriosis. Small bowel endometriosis should, therefore, be considered in the differential diagnosis of women of childbearing age who present with symptoms of obstruction.

Endometriosis of the appendix causing small bowel obstruction in a virgin abdomen

“…The serosa of the two distal segments were laparoscopically dissected free of endometriosis 3. There have been other reports of small bowel obstruction due to endometriotic ileal stricture requiring operative management 6 10. Interestingly but unrelated to the index patients’ presentation, there have been few reports of intussusception of the vermiform appendix secondary to appendiceal endometriosis 18 19.…”

“…These symptoms are generally worse during menstruation; however, this may not always be the case, making the condition challenging to diagnose. Although small bowel obstruction is a common presentation representing 20% of all surgical admissions for acute abdominal pain,6 endometriosis-related small bowel obstruction is extremely rare. The authors present an unusual case of small bowel obstruction secondary to endometriosis affecting the appendix, treated with laparoscopic adhesiolysis, and appendicectomy.…”

Terminal ilial intussusception in an adult due to endometriosis

“…It accounts for over 20 % of all hospital admissions due to acute abdominal pain. Malignant growths, strangulated herniae and adhesions are the common causes for small bowel obstruction in adults [ 5 ]. Endometriosis is the presence of endometrial tissue outside the uterus.…”

“…Intussusception is a common cause of bowel obstruction in children. Over 95 % of all reported intussusception cases have occured in children, whereas only 1–5 % were reported in adults [ 5 ]. In children intussusception is usually idiopathic or secondary to viral infections [ 6 ].…”

“…In children intussusception is usually idiopathic or secondary to viral infections [ 6 ]. However in adults, intussusception is usually due to ‘leading point’ [ 5 , 8 , 9 ]. Leading point usually is a lesion in the lumen of the bowel which interferes with the peristalsis process.…”