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Gurluler E, Isik O, Ugras N, Sahin A, Sen M, Yilmazlar T. Intestinal endometriosis amongst other extra-pelvic endometriosis foci presenting as acute/subacute bowel obstruction in women of reproductive age: a retrospective case series study. BMC Surg 2025; 25:12. [PMID: 39773490 PMCID: PMC11706109 DOI: 10.1186/s12893-024-02755-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Accepted: 12/31/2024] [Indexed: 01/11/2025] Open
Abstract
BACKGROUND This study aimed to investigate the prevalence and clinicopathological correlates of intestinal endometriosis, amongst other extra-pelvic endometriosis foci, presenting as bowel obstruction in general surgery practice. METHODS A total of 23 female patients (mean ± SD age: 34.9 ± 6.5 years) who underwent abdominal surgery for acute bowel obstruction and received histopathological diagnosis of endometriosis were included in this retrospective case-series study. Data on patient characteristics, obstetric history, preoperative laboratory and imaging findings, preoperative provisional diagnosis, type of surgical intervention and the pathological diagnosis, and postoperative outcomes were recorded. RESULTS Definitive diagnoses on histopathological work-up involved intestinal endometriosis (52.2%), scar endometriosis (26.0%), ovarian endometriosis (13.0%) and inguinal endometriosis (8.7%). Postoperative complication, reoperation and recurrence rates were 8.7%, 8.7%, and 13.0%, respectively. Intestinal endometriosis, when compared to other extra-pelvic endometriosis foci (scar and inguinal), was associated with significantly higher preoperative platelet counts (332.0(284.0-528.0)vs. 239.0(223.0-370.0) 103/µL, p = 0.010), lower albumin levels (4.0(2.7-4.7) vs. 4.5(4.2-4.9) g/dL, p = 0.029), higher rates of preoperative CT utilization (91.7% vs. 0.0%, p < 0.001) and emergent surgery (83.3% vs. 0.0%, p = 0.001) and longer LOS (median 4.5 (1.0-26.0) vs. 1.0(1.0-1.0) days, p = 0.001) along with a non-significant tendency for higher postoperative complication (16.7% vs. 0.0%) and ICU stay (25.0% vs. 0.0%) rates. CONCLUSION Our findings revealed intestinal endometriosis, predominantly in the terminal ileum/appendix, was the most common extra-pelvic cause of acute bowel obstruction. The scar endometriosis, inguinal endometriosis and ovarian endometriosis appeared to be other potential but less prevalent aetiologies in this setting.
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Affiliation(s)
- Ercument Gurluler
- Department of General Surgery, Uludag University Faculty of Medicine, Bursa, Turkey.
- Department of General Surgery, Uludag University Faculty of Medicine, Bursa, Turkey.
| | - Ozgen Isik
- Department of General Surgery, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Nesrin Ugras
- Department of Pathology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Aysun Sahin
- Department of General Surgery, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Murat Sen
- Department of General Surgery, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Tuncay Yilmazlar
- Department of General Surgery, Uludag University Faculty of Medicine, Bursa, Turkey
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2
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Mușat F, Păduraru DN, Bolocan A, Constantinescu A, Ion D, Andronic O. Endometriosis as an Uncommon Cause of Intestinal Obstruction-A Comprehensive Literature Review. J Clin Med 2023; 12:6376. [PMID: 37835020 PMCID: PMC10573381 DOI: 10.3390/jcm12196376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/20/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
The prevalence of intestinal endometriosis has been estimated to be between 3% and 37% of all endometriosis cases. Cases of intestinal occlusion due to endometriosis foci on the small bowel and on the large bowel are even rarer, with a reported prevalence of 0.1-0.7%. The aim of this literature review was to summarize the available published evidence on the diagnosis, characteristics, and management of intestinal occlusion due to endometriosis. The search on PubMed retrieved 295 records, of which 158 were rejected following a review of the title and abstract. After reviewing the full text, 97 studies met the Population, Intervention, Comparator, Outcomes, and Study (PICOS) criteria and were included in the analysis. The total number of patients with bowel occlusion due to endometriosis included in the studies was 107. The occlusive endometrial foci were localized on the ileum in 38.3% of the cases, on the rectosigmoid in 34.5% of the cases, at the ileocecal junction and the appendix in 14.9% of the cases, and at the rectum in 10.2% of the cases. Only one case reported large bowel obstruction by endometriosis of the hepatic flexure of the colon extending to the transverse colon (0.9%), and in one case the obstruction was caused by an omental giant endometrioid cyst compressing the intestines. We identified six cases of postmenopausal females with acute bowel obstruction due to endometriosis. Malignant degeneration of endometriosis was also identified as a cause of intestinal occlusion. The mechanisms of obstruction include the presence of a mass in the lumen of the intestine or in the wall of the intestine, extrinsic compression, adhesions, or intussusception.
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Affiliation(s)
- Florentina Mușat
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, The University Emergency Hospital of Bucharest, 050098 Bucharest, Romania; (F.M.); (A.B.); (D.I.); (O.A.)
| | - Dan Nicolae Păduraru
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, The University Emergency Hospital of Bucharest, 050098 Bucharest, Romania; (F.M.); (A.B.); (D.I.); (O.A.)
| | - Alexandra Bolocan
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, The University Emergency Hospital of Bucharest, 050098 Bucharest, Romania; (F.M.); (A.B.); (D.I.); (O.A.)
| | - Alexandru Constantinescu
- Gastroenterology Department, Carol Davila University of Medicine and Pharmacy, The University Emergency Hospital of Bucharest, 050098 Bucharest, Romania;
| | - Daniel Ion
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, The University Emergency Hospital of Bucharest, 050098 Bucharest, Romania; (F.M.); (A.B.); (D.I.); (O.A.)
| | - Octavian Andronic
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, The University Emergency Hospital of Bucharest, 050098 Bucharest, Romania; (F.M.); (A.B.); (D.I.); (O.A.)
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Kobayashi K, Yamadera M, Takeo H, Murayama M. Small bowel obstruction caused by appendiceal and ileal endometriosis: a case report. J Surg Case Rep 2022; 2022:rjac282. [PMID: 35721264 PMCID: PMC9200432 DOI: 10.1093/jscr/rjac282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Endometriosis is characterized by the presence of an ectopic endometrial gland. Intestinal endometriosis with small bowel obstruction is uncommon. In this case, a 37-year-old woman with no history of endometriosis presented with a chief complaint of abdominal pain. Computed tomography revealed a distal small bowel obstruction. Surgical intervention was performed because of the emergent abdominal condition and the potential resistance to conservative management. Histopathological examination revealed appendiceal and ileal endometriotic lesions. Preoperative diagnosis was difficult because there were no specific clinical features. Intraoperatively, it is difficult to distinguish intestinal endometriosis and bowel malignancy; thus, oncological resection should be performed.
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Affiliation(s)
- Kazuki Kobayashi
- Department of Surgery, Self-Defence Forces Central Hospital , Setagaya , Japan
| | - Masato Yamadera
- Department of Surgery, Self-Defence Forces Central Hospital , Setagaya , Japan
| | - Hiroaki Takeo
- Department of Diagnostic Pathology, Self-Defence Forces Central Hospital , Setagaya , Japan
| | - Michinori Murayama
- Department of Surgery, Self-Defence Forces Central Hospital , Setagaya , Japan
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Lam K, Lang E. Endometriosis as a rare cause of small bowel obstruction. ANZ J Surg 2020; 90:E137-E138. [PMID: 32339367 DOI: 10.1111/ans.15916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/08/2020] [Accepted: 04/10/2020] [Indexed: 01/07/2023]
Affiliation(s)
- Kenneth Lam
- Department of Surgery, Monash Health, Melbourne, Victoria, Australia
| | - Emma Lang
- Department of Surgery, Monash Health, Melbourne, Victoria, Australia
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5
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Zhu MY, Fei FM, Chen J, Zhou ZC, Wu B, Shen YY. Endometriosis of the duplex appendix: A case report and review of the literature. World J Clin Cases 2019; 7:2094-2102. [PMID: 31423443 PMCID: PMC6695541 DOI: 10.12998/wjcc.v7.i15.2094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/18/2019] [Accepted: 06/26/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Duplication of the appendix is an infrequent congenital malformation with a complex classification. The horseshoe appendix is a subtype of the duplex appendix and is rarely reported in the literature. Endometriosis is a common gynecological disease that rarely occurs in the appendix. Moreover, horseshoe appendix combined with endometriosis has not been previously reported. CASE SUMMARY Here, we describe a 44-year-old woman who was admitted with a 1-d history of migratory lower right quadrant pain. Physical examination was consistent with the signs of acute appendicitis. The patient underwent an emergency exploratory laparotomy. The distal tip of the appendix was in contact with the cecum by another base, or "horseshoe appendix". In addition, a small intestinal mass and an ovarian mass were identified. Subsequently, appendectomy, partial resection of the small intestine, and right oophorectomy were successively performed. The histopathology confirmed the diagnosis of acute inflammation of the duplex appendix with endometriosis, small intestine endometriosis, and ovarian endometriosis. CONCLUSION Surgeons need to be aware of the possibility of the duplex appendix when performing an appendectomy, and this study emphasizes the importance of exploring the entire abdomen.
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Affiliation(s)
- Ming-Yuan Zhu
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Fa-Ming Fei
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Jing Chen
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Zhong-Cheng Zhou
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Bin Wu
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Yi-Yu Shen
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
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Choi JDW, Yunaev M. Endometriosis of the appendix causing small bowel obstruction in a virgin abdomen. BMJ Case Rep 2019; 12:12/7/e230496. [PMID: 31337629 DOI: 10.1136/bcr-2019-230496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
A 29-year-old, otherwise well, nulligravid woman presented to the emergency department with 1-day history of generalised abdominal pain and vomiting. She had similar symptoms 6 months prior following recent menstruations, which resolved conservatively. She had no prior history of abdominal surgery or endometriosis. CT scan demonstrated distal small bowel obstruction. A congenital band adhesion was suspected, and she underwent prompt surgical intervention. During laparoscopy, a thickened appendix was adhered to a segment of distal ileum. There was blood in the pelvis. Laparoscopic adhesiolysis and appendicectomy were performed. Histopathology demonstrated multiple foci of endometriosis of the appendix with endometrial glands surrounded by endometrial stroma. Oestrogen receptor and CD10 immunostains highlighted the endometriotic foci. The patient made a good recovery and was referred to a gynaecologist for further management.
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Affiliation(s)
- Joseph Do Woong Choi
- Department of Surgery, Norwest Private Hospital, Sydney, New South Wales, Australia
| | - Michael Yunaev
- Department of Surgery, Norwest Private Hospital, Sydney, New South Wales, Australia
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Gastrointestinal and Urinary Tract Endometriosis: A Review on the Commonest Locations of Extrapelvic Endometriosis. Adv Med 2018; 2018:3461209. [PMID: 30363647 PMCID: PMC6180923 DOI: 10.1155/2018/3461209] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/07/2018] [Indexed: 02/06/2023] Open
Abstract
Extrapelvic endometriosis is a rare entity that presents serious challenges to researchers and clinicians. Endometriotic lesions have been reported in every part of the female human body and in some instances in males. Organs that are close to the uterus are more often affected than distant locations. Extrapelvic endometriosis affects a slightly older population of women than pelvic endometriosis. This might lead to the assumption that it takes several years for pelvic endometriosis to "metastasize" outside the pelvis. All current theories of the pathophysiology of endometriosis apply to some extent to the different types of extrapelvic endometriosis. The gastrointestinal tract is the most common location of extrapelvic endometriosis with the urinary system being the second one. However, since sigmoid colon, rectum, and bladder are pelvic organs, extragenital pelvic endometriosis may be a more suitable definition for endometriotic implants related to these organs than extrapelvic endometriosis. The sigmoid colon is the most commonly involved, followed by the rectum, ileum, appendix, and caecum. Most lesions are confined in the serosal layer; however, deeper lesion can alter bowel function and cause symptoms. Bladder and ureteral involvement are the most common sites concerning the urinary system. Unfortunately, ureteral endometriosis is often asymptomatic leading to silent obstructive uropathy and renal failure. Surgical excision of the endometriotic tissue is the ideal treatment for all types of extrapelvic endometriosis. Adjunctive treatment might be useful in selected cases.
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8
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Bacalbasa N, Balescu I, Filipescu A. Ileocecal Obstruction Due to Endometriosis - A Case Report and Literature Review. In Vivo 2017; 31:999-1002. [PMID: 28882972 PMCID: PMC5656879 DOI: 10.21873/invivo.11160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 08/08/2017] [Accepted: 08/09/2017] [Indexed: 12/29/2022]
Abstract
Endometriosis is a common finding in premenopausal women and a significant number of cases presenting digestive tract involvement at the time of diagnosis. However, most of these patients present pelvic nodules involving the rectosigmoidian junction, other digestive tract segments being less commonly affected. We present the case of a 37-year-old nulliparous woman who presented for diffuse abdominal pain and vomiting; she was diagnosed with complete ileocecal obstruction due to an endometriosis nodule in association with bilateral ovarian endometriosis lesions invading the rectosigmodian wall. A right colectomy with ileocolic anastomosis in association with bilateral cystectomy and rectosigmodian resection was successfully performed. The histopathological examination confirmed the endometriosic origin of the nodules invading the rectosigmodian and ileocecal wall, that was similar to the one described at the level of the ovarian cysts.
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Affiliation(s)
- Nicolae Bacalbasa
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Alexandru Filipescu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- "Elias" Emergency University Hospital, Bucharest, Romania
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9
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Gupta R, Mittal P, Mittal A, Gupta S, Mittal K, Taneja A. Spectrum of MDCT Findings in Bowel Obstruction in a Tertiary Care Rural Hospital in Northern India. J Clin Diagn Res 2017; 10:TC01-TC04. [PMID: 28050471 DOI: 10.7860/jcdr/2016/21186.8781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 08/04/2016] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Multidetector Computed Tomography (MDCT) provides clinically and surgically important information in bowel obstruction. It can depict the severity, level and cause of obstruction. AIM To depict the spectrum of MDCT findings in cases of small and large bowel obstruction. MATERIALS AND METHODS Contrast enhanced MDCT examination of 50 patients were retrospectively included in the study who had evidence of clinical as well as MDCT evidence of bowel obstruction and in whom surgical/clinical follow-up for final diagnosis was available. CT scan was done in all the patients with Ingenuity CT (128 slice MDCT, Philips Medical Systems). The axial sections were reconstructed in coronal and sagital planes to determine site and cause of bowel obstruction. RESULTS There were 34 males and 16 females patients in this study with mean age of 28.4 years. The level of obstruction was in small bowel in 39 patients (76.67%) and large bowel in 11 patients (23.33%). Adhesive bands were the cause of Small Bowel Obstruction (SBO) in 17 patients (43.5% of SBO patients). The most common CT signs in adhesive band SBO were beak sign (seen in 70.6% patients) and fat notch sign (52.9% patients). Five cases of SBO were secondary to benign stricture. Matted adhesions were the cause of obstruction in 3 patients. All these patients showed transition zone in pelvis with positive small bowel faeces sign. Two patients with SBO due to adhesive band had evidence of closed loop obstruction with evidence of gangrenous gut on surgery. Large Bowel Obstruction (LBO) was seen in 11 patients. Most common cause of LBO was primary colonic malignancy, accounting for 7 patients (63.6%). In one patient, the cause was direct invasion of hepatic flexure by carcinoma of gall bladder. Other causes of LBO were pelvic adhesions, faecal impaction and ischaemic stricture. CONCLUSION SBO is more common than LBO with adhesive bands being the most common cause of SBO. MDCT is very useful for depicting site and cause of obstruction and any associated complications.
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Affiliation(s)
- Ranjana Gupta
- Associate Professor, Department of Radiodiagnosis, Maharishi Markandeshwar Institute of Medical Sciences and Research , Mullana, Ambala, Haryana, India
| | - Puneet Mittal
- Associate Professor, Department of Radiodiagnosis, Maharishi Markandeshwar Institute of Medical Sciences and Research , Mullana, Ambala, Haryana, India
| | - Amit Mittal
- Professor and Head, Department of Radiodiagnosis, Maharishi Markandeshwar Institute of Medical Sciences and Research , Mullana, Ambala, Haryana, India
| | - Sharad Gupta
- Resident, Department of Radiodiagnosis, Maharishi Markandeshwar Institute of Medical Sciences and Research , Mullana, Ambala, Haryana, India
| | - Kapish Mittal
- Resident, Department of Radiodiagnosis, Maharishi Markandeshwar Institute of Medical Sciences and Research , Mullana, Ambala, Haryana, India
| | - Arpit Taneja
- Resident, Department of Radiodiagnosis, Maharishi Markandeshwar Institute of Medical Sciences and Research , Mullana, Ambala, Haryana, India
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Darvishzadeh A, McEachern W, Lee TK, Bhosale P, Shirkhoda A, Menias C, Lall C. Deep pelvic endometriosis: a radiologist's guide to key imaging features with clinical and histopathologic review. Abdom Radiol (NY) 2016; 41:2380-2400. [PMID: 27832323 DOI: 10.1007/s00261-016-0956-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
While endometriosis typically affects the ovaries, deep infiltrating endometriosis can affect the gastrointestinal tract, urinary tract, and deep pelvis, awareness of which is important for radiologists. Symptoms are nonspecific and can range from chronic abdominal and deep pelvic pain to nausea, vomiting, diarrhea, constipation, hematuria, and rectal bleeding. Ultrasound and computed tomography may show nonspecific soft-tissue density masses causing bowel obstruction and hydronephrosis. This constellation of presenting symptoms and imaging evidence is easily mistaken for other pathologies including infectious gastroenteritis, diverticulitis, appendicitis, and malignancy, which may lead to unnecessary surgery or mismanagement. With this, deep pelvic endometriosis should be considered in the differential diagnosis in a female patient of reproductive age who presents with such atypical symptoms, and further work up with magnetic resonance imaging is imperative for accurate diagnosis, treatment selection, and preoperative planning.
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Affiliation(s)
- Ayeh Darvishzadeh
- Department of Radiology, University of California Irvine School of Medicine, 1001 Health Sciences Road, Irvine, CA, 92617, USA.
| | | | - Thomas K Lee
- Department of Pathology, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Priya Bhosale
- Division of Diagnostic Imaging, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Ali Shirkhoda
- Department of Radiology, University of California Irvine School of Medicine, 1001 Health Sciences Road, Irvine, CA, 92617, USA
| | | | - Chandana Lall
- Department of Radiology, University of California Irvine School of Medicine, 1001 Health Sciences Road, Irvine, CA, 92617, USA
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Arer IM, Yabanoglu H, Hasbay B. Anastomotic Leakage in a Patient with Acute Intestinal Obstruction Secondary to Appendiceal and Ileal Endometriosis: A Case Report. J Clin Diagn Res 2016; 10:PD21-2. [PMID: 27190890 DOI: 10.7860/jcdr/2016/18530.7660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 02/15/2016] [Indexed: 11/24/2022]
Abstract
Endometriosis is a commonly encountered problem in women of reproductive age. It usually causes chronic abdominal pain. However, it rarely causes complications such as intestinal obstruction. The most commonly performed procedure for these patients is bowel resection and anastomosis. Unless it is complicated with anastomotic leakage. We present a 39-year-old woman presented with intestinal obstruction due to appendiceal and ileal endometriosis complicated with anastomotic leakage after surgery.
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Affiliation(s)
- Ilker Murat Arer
- Department of General Surgery, Baskent University Adana Teaching and Research Center , Adana, Turkey
| | - Hakan Yabanoglu
- Assistant Professor, Department of General Surgery, Baskent University Adana Teaching and Research Center , Adana, Turkey
| | - Bermal Hasbay
- Department of Pathology, Baskent University Adana Teaching and Research Center , Adana, Turkey
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12
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Sali PA, Yadav KS, Desai GS, Bhole BP, George A, Parikh SS, Mehta HS. Small bowel obstruction due to an endometriotic ileal stricture with associated appendiceal endometriosis: A case report and systematic review of the literature. Int J Surg Case Rep 2016; 23:163-8. [PMID: 27153232 PMCID: PMC5022069 DOI: 10.1016/j.ijscr.2016.04.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 04/09/2016] [Accepted: 04/13/2016] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Endometriosis is defined as the presence of functional ectopic endometrial tissue outside the uterine cavity. It rarely involves the small bowel and obstruction due to the same is highly uncommon. Preoperative diagnosis is difficult based on clinical and radiological studies. Diagnosis can be confirmed only on histopathological examination of the surgically resected specimen. PRESENTATION OF CASE A 44 years old lady presented with repeated episodes of abdominal pain, non bilious vomiting and diarrhea. She also gave history of abdominal pain during every menstruation. She had diffuse abdominal tenderness and the computed tomography showed a concentric infective/inflammatory thickening of the distal ileum. Colonoscopy confirmed a tight distal ileal stricture After a failed trial of conservative management, she underwent a laparoscopic right hemicolectomy. The histopathological examination revealed multiple endometriotic foci in the ileum and the appendix. DISCUSSION Ileal endometriosis presenting as obstruction is uncommon and very few cases have been reported thus far. The symptoms are usually cyclical but may later become continuous with the progression of the disease. Preoperative diagnostic dilemma is due to the clinical and the radiological similarities to inflammatory, infective and irritable bowel diseases. CONCLUSION Ours is probably the first case of small bowel obstruction due to ileal and appendiceal endometriosis that was managed with laparoscopic right hemicolectomy. We highlight the preoperative diagnostic dilemma and the progression of the cyclical symptoms. Thus, endometriosis must be considered in cases of small bowel obstruction in women in the reproductive age group as a rare cause.
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Affiliation(s)
- Priyanka A Sali
- Department of Gastro-Intestinal Surgery, Lilavati Hospital and Research Centre, A-791, Bandra Reclamation, Bandra west, Mumbai 400 0050, Maharashtra, India.
| | - Kamal S Yadav
- Department of Gastro-Intestinal Surgery, Lilavati Hospital and Research Centre, A-791, Bandra Reclamation, Bandra west, Mumbai 400 0050, Maharashtra, India.
| | - Gunjan S Desai
- Department of Gastro-Intestinal Surgery, Lilavati Hospital and Research Centre, A-791, Bandra Reclamation, Bandra west, Mumbai 400 0050, Maharashtra, India.
| | - Bhushan P Bhole
- Department of Gastro-Intestinal Surgery, Lilavati Hospital and Research Centre, A-791, Bandra Reclamation, Bandra west, Mumbai 400 0050, Maharashtra, India.
| | - Asha George
- Department of Pathology, Lilavati Hospital and Research Centre, A-791, Bandra Reclamation, Bandra west, Mumbai 400 0050, Maharashtra, India.
| | - Samir S Parikh
- Department of Gastroenterolgy, Lilavati Hospital and Research Centre, A-791, Bandra Reclamation, Bandra west, Mumbai 400 0050, Maharashtra, India.
| | - Hitesh S Mehta
- Department of Gastro-Intestinal Surgery, Lilavati Hospital and Research Centre, A-791, Bandra Reclamation, Bandra west, Mumbai 400 0050, Maharashtra, India.
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Torralba-Morón A, Urbanowicz M, Ibarrola-De Andres C, Lopez-Alonso G, Colina-Ruizdelgado F, Guerra-Vales JM. 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. Intern Med 2016; 55:2595-9. [PMID: 27629952 DOI: 10.2169/internalmedicine.55.6461] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Endometriosis is a quite common pathology, however, intestinal endometriosis is a rare condition, which typically occurs with chronic symptoms. Its acute presentation is very infrequent. We herein report four cases of intestinal endometriosis, in which the clinical debut occurred acutely: two as an acute small bowel obstruction and two as a small bowel perforation. None of the cases had a preoperative diagnosis of endometriosis. The interest of these cases lies in this exceptional form of presentation, such as a surgical acute abdomen. Therefore, intestinal endometriosis should be taken into account in the differential diagnosis of an acute obstructive or perforative process of the small or large bowel.
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14
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Izuishi K, Sano T, Shiota A, Mori H, Ebara K. Small bowel obstruction caused by endometriosis in a postmenopausal woman. Asian J Endosc Surg 2015; 8:205-8. [PMID: 25913589 DOI: 10.1111/ases.12154] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 09/28/2014] [Accepted: 09/30/2014] [Indexed: 12/28/2022]
Abstract
We report a rare case of small bowel obstruction (SBO) caused by endometriosis in a postmenopausal woman. A 54-year-old postmenopausal woman presented with severe abdominal pain and vomiting. Before menopause, she sometimes had abdominal pain associated with menses. Axial multi-dimensional CT images revealed a SBO with small nodules near the terminal ileum. The obstruction was diagnosed as being caused by small bowel endometriosis. Curved planar reconstruction images showed a complicated obstruction of the small intestine 15 cm from the terminal ileum. Based on the stenotic lesion, a SILS procedure was performed. The patient's SBO diagnosis was histologically confirmed as being caused by small bowel endometriosis. SILS was deemed to be a safe, feasible procedure for treating this bowel obstruction. Curved planar reconstruction images were useful in preoperative imaging and diagnosis of SBO, especially as they were able to highlight the constricting legion.
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Affiliation(s)
- Kunihiko Izuishi
- Department of Gastroenterological Surgery, Federation of Public Services and Affiliated Personnel Aid Associations, Takamatsu Hospital, Takamatsu, Kagawa, Japan
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15
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Soumekh A, Nagler J. Gastrointestinal endometriosis causing subacute intestinal obstruction with gradual development of weight loss and misdiagnosed as irritable bowel syndrome. Case Rep Gastroenterol 2014; 8:51-5. [PMID: 24574950 PMCID: PMC3934607 DOI: 10.1159/000358552] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Both endometriosis and irritable bowel syndrome (IBS) are commonly found in young women and the diagnosis of either is challenging. Alarm symptoms can exclude the diagnosis of IBS, but their onset may be insidious and often no evidence of organic disease may be found. We present a patient with a 4-year history of presumed IBS, absent gynecological symptoms, negative gastrointestinal as well as gynecological testing who developed the only alarm symptom of weight loss and was eventually found to have endometriosis of the small intestine. This case illustrates the need for constant vigilance in patients with IBS.
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Affiliation(s)
- Amir Soumekh
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medical College, New York, N.Y., USA
| | - Jerry Nagler
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medical College, New York, N.Y., USA
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16
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Upreti S, Bansal R, Upreti S, Mathur S. Stromal endometriosis of the intestine: an elusive presentation with a review of the literature: a case report. J Clin Diagn Res 2013; 7:378-80. [PMID: 23543811 DOI: 10.7860/jcdr/2013/5075.2775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 12/05/2012] [Indexed: 01/07/2023]
Abstract
Although endometriosis involves the small intestine only rarely, when present, this condition may simulate a variety of inflammatory and sometimes neoplastic conditions because of its nonspecific symptoms. We are reporting here, a case of ileal, caecal and appendiceal endometriosis which presented in the emergency as a case of an acute intestinal obstruction with a long history of symptoms which were referable to the GI tract. The patient had the diffuse involvement of a segment of the ileum with mural thickening and luminal narrowing, which led to obstruction. The literature on small bowel endometriosis has been reviewed and the clinical and pathological features have been discussed.
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17
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Affiliation(s)
- Sophocles Lanitis
- Second Surgical Department and Unit of Surgical Oncology, "Korgialenio - Benakio", Red Cross Athens General Hospital, Athens, Greece
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18
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Vieille P, Masia F, Donici I, Laporte S, Mares P, de Tayrac R. Un cas d’occlusion digestive sur lésion d’endométriose sous agoniste de la GnRH. ACTA ACUST UNITED AC 2012; 41:668-71. [DOI: 10.1016/j.jgyn.2012.04.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 04/14/2012] [Accepted: 04/18/2012] [Indexed: 01/07/2023]
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