Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 26, 2019; 7(4): 441-451
Published online Feb 26, 2019. doi: 10.12998/wjcc.v7.i4.441
Intestinal endometriosis: Diagnostic ambiguities and surgical outcomes
Jun Woo Bong, Chang Sik Yu, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Jin Cheon Kim
Jun Woo Bong, Chang Sik Yu, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Jin Cheon Kim, Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul 05505, South Korea
Author contributions: Bong JW contributed to the manuscript writing, performing data collecting and analysis; Yu CS contributed to the drafting conception and design; Lee JL, Kim CW and Yoon YS contributed to the collecting data; Park IJ, Lim SB and Kim JC contributed to the confirmation results.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of Asan Medical Center.
Informed consent statement: This study is retrospective study and informed consent is waived because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment.
Conflict-of-interest statement: There is no conflict of interest or no source of support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Chang Sik Yu, MD, PhD, Professor, Surgeon, Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea. csyu@amc.seoul.kr
Telephone: +82-2-30103494 Fax: +82-2-30106701
Received: November 5, 2018
Peer-review started: November 5, 2018
First decision: December 20, 2018
Revised: January 9, 2019
Accepted: January 26, 2019
Article in press: January 26, 2019
Published online: February 26, 2019
Processing time: 114 Days and 2.7 Hours
ARTICLE HIGHLIGHTS
Research background

The intestinal endometriosis is a disease that endometrial tissue involves the small or large intestine. Endometriosis is relatively common disease, but intestinal endometriosis is very rare and it is difficult to diagnose preoperatively.

Research motivation

A young woman who was diagnosed with Crohn’s disease and under medical treatment for about 3 years at our hospital had suffered severe abdominal paint at right lower quadrant. We had found severe stricture of terminal ileum at computed tomography (CT) images. We had misdiagnosed her as acute phase of Crohn’s disease, but the pathologic result was intestinal endometriosis. After that, we reviewed similar cases in our institution and identified there was several misdiagnosed cases before operations. We had also searched similar studies, but not enough information was acquired with their clinical characteristics.

Research objectives

We aimed to evaluate the clinical characteristics of misdiagnosed cases before surgery and tried to suggest ways to reduce those cases.

Research methods

We retrospectively reviewed medical records of patients who had been diagnosed with intestinal endometriosis from their surgical specimens. Fifty patients were identified and 20 cases were excluded because the diagnosis of intestinal endometriosis was made incidentally during surgical resection for other pathologies. A total of 30 patients were included in this study and their clinical characteristics including age, history of abdominal surgery or endometriosis were evaluated. Clinical presentation, CT imaging, endoscopic findings were also evaluated and preoperative diagnosis, locations of lesions, types of bowel surgeries, and combined operations were analyzed.

Research results

According to preoperative evaluations, 13 patients (43.3%) had an initial diagnosis of pelvic endometriosis and 17 patients (56.6%) were misdiagnosed as having other diseases. Only 4 patients (13.3%) had a diagnosis of endometriosis based on endoscopic biopsy findings. The most common misdiagnosis was submucosal tumor in the large intestine (n = 8, 26.7%), followed by malignancies of the colon/rectum (n = 3, 10.0%) and ovary (n = 3, 10.0%).

Research conclusions

Symptoms of intestinal endometriosis mimic various intestinal diseases, thus it is difficult to diagnose preoperatively. Intestinal endometriosis should be considered when women of reproductive age have ambiguous symptoms and signs with preoperative evaluations.

Research perspectives

It will be meaningful to study about more long term results of patients with intestinal endometriosis and their potency of malignant formation.