Small bowel obstruction due to subserosal endometriosis: an elusive condition

Mishra, Garima; Vats, Manu; Pandey, Diwakar; Akhtar, Azaz

doi:10.18203/2320-1770.ijrcog20160610

Cited by 2 publications

(8 citation statements)

References 20 publications

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“…1,2 However, once the endometrial lesions have caused subsequent fibrosis and stricture formation, the abdominal pain may lack a cyclical nature. 1,3 In this case, the patient did not report any pre-existing abdominal pain while on dienogest. She presented to the emergency department with gradual onset crampy abdominal pain and postprandial distension.…”

mentioning

confidence: 69%

“…Endometriosis causing an acute bowel obstruction occurs in <1% of patients with intestinal endometriosis 2. When the gastrointestinal tract is involved, only 7% of cases involve the small bowel 3…”

Section: Figurementioning

confidence: 99%

“…2,3 Other theories include cell metaplasia of pluripotential peritoneal mesothelium or Mullerian remnants and the infiltration of bowel wall by endometrial tissue via nerves. 1,3 The invasion of endometrial tissue at ectopic areas such as small bowel is mediated by neovascularization by proangiogenic factors like vascular endothelial growth factor. 2 Local inflammation then results in fibrosis and the formation of adhesions.…”

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confidence: 99%

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Endometriosis as a rare cause of small bowel obstruction

Lam

Lang

2020

ANZ Journal of Surgery

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Endometriosis as a rare cause of small bowel obstruction Acute small bowel obstruction (SBO) secondary to intestinal endometriosis is a rare pathology that requires major surgery. Endometriosis can be a chronic painful disease characterized by the presence of functional endometrial tissue outside of the uterus. 1 It is important to think about endometriosis as a cause of an SBO. We present a 49-year-old female with a 12-h history of nausea, abdominal distension and postprandial pain. Diagnostic laparoscopy 2 years previously for generalized abdominal discomfort confirmed a grade 4 endometrioma. The patient managed her endometriosis medically with dienogest, a synthetic progesteronelike hormone. On examination, the abdomen examined soft but appeared distended. A computed tomography of the abdomen and pelvis revealed a high-grade SBO with a transition point in the distal ileum secondary to a suggested ovoid intraluminal density concerning for malignancy (Fig. 1). At laparotomy, 30 cm from the ileocaecal valve, the ileum could be seen twisting on itself in a ushape via an interloop adhesion. At the twist, a 2 × 2 cm intraluminal density was palpated. There was no obvious scarring of the serosa. Small bowel was distended proximal to the u-loop and collapsed distally. Histology confirmed evidence of endometriosis involving the serosa of the ileum (Fig. 2). Fifteen centimetres of ileum was resected with an end-to-end anastomosis performed. The patient had an uneventful post-operative recovery. Endometriosis causing an acute bowel obstruction occurs in <1% of patients with intestinal endometriosis. 2 When the gastrointestinal tract is involved, only 7% of cases involve the small bowel. 3 Fig. 1. Computed tomography of the abdomen and pelvis with intravenous contrast showing (a) axial and (b) coronal views. There is a high-grade mechanical small bowel obstruction in the distal small bowel secondary to an ovoid intraluminal density (arrows).

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confidence: 69%

Section: Figurementioning

confidence: 99%

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confidence: 99%

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Endometriosis as a rare cause of small bowel obstruction

Lam

Lang

2020

ANZ Journal of Surgery

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“…Transmural endometriosis refers to the involvement of the serosa, the muscularis propria, the submucosa, and the mucosa of the intestinal wall, by endometriotic foci [ 9 ]. From the patients that present with obstruction, 10% have transmural endometriosis [ 13 ]. As was the case with our patient.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical resection can be performed via laparoscopy or laparotomy. A multidisciplinary approach with Surgery, Gynecology, and Gastroenterology, is recommended [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Ileal obstruction caused by transmural endometriosis in a patient with simultaneous C. difficile colitis and Influenza AH1N1. Case report

Santos-Manzur

Valdez-Bocanegra

Ornelas-Flores

et al. 2020

International Journal of Surgery Case Reports

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Highlights Bowel obstruction or intestinal occlusion caused by endometriosis is very rare. Endometriotic nodules induce luminal stenosis and ileal obstruction. Transmural endometriosis infiltrates the four layers of the intestinal wall. Diagnosis is established through pathological and immunohistochemical analysis. The treatment of choice is bowel resection via laparoscopy or laparotomy.

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Small bowel obstruction due to subserosal endometriosis: an elusive condition

Cited by 2 publications

References 20 publications

Endometriosis as a rare cause of small bowel obstruction

Endometriosis as a rare cause of small bowel obstruction

Ileal obstruction caused by transmural endometriosis in a patient with simultaneous C. difficile colitis and Influenza AH1N1. Case report

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