Postmenopausal intestinal obstructive endometriosis: case report and review of the literature

Abstract

CONTEXT: Endometriosis is characterized by the presence of endometrial tissue outside the uterine cavity, which is commonly detected in gynecological practice but rarely reported as a coloproctological disorder. The objective of the present report was to discuss a rare case of postmenopausal intestinal endometriosis simulating a malignant lesion, following a review of the literature. CASE REPORT: A 74-year-old woman with complaints of hematochezia and tenesmus of two months' duration accompanied by liquid feces and pelvic pain, but with no other gastrointestinal or gynecological complaints, was referred to our service. She had been menopausal for 22 years, with no hormone replacement treatment, and had undergone panhysterectomy three years before the referral to us, due to endometrial thickening and a right adnexal cyst. Five months before this referral, she had undergone laparotomy due to acute obstructive abdomen, which revealed a tumor mass involving the small bowel. Anatomopathological examination of the enterectomy suggested a hypothesis of intestinal endometriosis. A proctological examination was normal. Computed tomography of the pelvis revealed thickening of the rectosigmoid transition and colonoscopy revealed friable tumor formation in the rectum. A biopsy of the lesion revealed mucosal fragments of endometrial type, which led to a review of the previous anatomopathological examination. The patient underwent rectosigmoidectomy with protective transversotomy, with a good postoperative course, and anatomical examination confirmed the intestinal endometriosis. The patient subsequently suffered a stenosing recurrence of the lesion and has undergone colostomy since then.

Obstrução intestinal causada por endometriose

“…Intestinal involvement in endometriosis occurs in 3% to 37%. The rectum and sigmoid are responsible for 73% of cases and the rectovaginal septum by 13% followed, in descending order, the ileocecal appendix, terminal ileum and cecum 1,4,6,7,10,11,12,13 .…”

“…E ndometriosis is the presence of functioning endometrial tissue outside the uterine cavity 2,3,6,7,8,10,12,13 . It is hormone dependent disease that affects women in reproductive age 1,3,4,6,7,9,10 .…”

“…It is hormone dependent disease that affects women in reproductive age 1,3,4,6,7,9,10 . The most common sites are the intrapelvic such as ovaries, uterin tubes, fornix, uterus, sacral ligament, pelvic peritoneum 2,6,7,8,12,13 .…”

“…It can also occurs in distant organs like the lungs, pleura, liver, gastrointestinal tract, central nervous system, skin, striated muscle 4,6,8 . In the digestive tract the most affected sites in descending order are the rectum, sigmoid colon, ileocecal appendix, terminal ileum and cecum 1,4,6,7,10,11,12,13 . The diagnosis of endometriosis can be difficult because of its nonspecific symptoms.…”

“…The diagnosis of endometriosis can be difficult because of its nonspecific symptoms. When located in the large intestine the distinction with malignancies, inflammatory and stenosis should always be suspected 6,8,9,10,11,13 .…”