Consequences of delayed diagnosis of acute gastrointestinal intussusception, secondary to endometriosis

Abstract

Ileocecocolic intussusception due to cecal endometriotic lesion is extremely rare, with symptoms that are often non‐specific, and delay in receiving support is resented by patients. We report the case of a 39‐year‐old woman who presented with major complications as a result of delayed diagnosis of cecal endometriosis. She experienced a diagnostic error that led to medical abortion for intractable vomiting, for which the pregnancy had been considered the only cause, resulting in secondary infertility. Six years later, she developed acute bowel intussusception after surgical treatment of rectal endometriosis requiring emergency surgery with ileocecal resection. After review of the literature, we draw attention to the major consequences of delay in diagnosis in the present case. Consequently, cecal location must not be missed in the diagnostic workup of gastrointestinal endometriosis.

The severity and frequency distribution of endometriosis subtypes at different ages: a model to understand the natural history of endometriosis based on single centre/single surgeon data

“…performed (Schenken, 2006;Hudelist et al, 2012;Chantalat et al, 2017;van der Zanden et al, 2018) the interval between the onset of endometriosis lesions and the laparoscopy, can be estimated to vary up to more than 10 years. Puberty and menarche suddenly change and probably increase a women's risk of initiating endometriosis.…”

“…The difference with our data could be due to the differences between referral centres, and global data in a country with probably an underestimation of subtle lesions. Considering that after initiation, endometriosis lesions need to grow to become symptomatic and considering the well known variable diagnostic delay before a laparoscopy is performed ( Schenken, 2006 ; Hudelist et al, 2012 ; Chantalat et al, 2017 ; van der Zanden et al, 2018 ) the interval between the onset of endometriosis lesions and the laparoscopy, can be estimated to vary up to more than 10 years. Puberty and menarche suddenly change and probably increase a women’s risk of initiating endometriosis.…”

“…Girls below 14 years of age are absent from this series since in Leuven, patients up to age 14 are seen by paediatricians and referred to the department of surgery. A second bias is that the intake of medical therapy for a variable duration of time before surgery cannot be excluded ( Schenken, 2006 ; Hudelist et al, 2012 ; Chantalat et al, 2017 ; van der Zanden et al, 2018 ). A third bias is a referral bias with relatively more severe endometriosis since Leuven University Hospital Gasthuisberg was a referral centre for deep endometriosis since the early nineties ( Cornillie et al, 1990 ).…”

Refractory epigastric pain secondary to intussusception caused by cecal endometriosis

“…Intestinal endometriosis is an extremely rare type of extragenital endometriosis, and cecal endometriosis accounts for approximately 3%-10% of all varieties of gastrointestinal endometriosis. 1 Optimal treatment of cecal endometriosis remains unknown. Medical therapy is recommended for endometriosis of the sigmoid colon and the rectum; however, its efficacy for other types of intestinal endometriosis remains unclear.…”

Ileocecal intussusception extending to left colon due to endometriosis

“…1 We found six other reports by searching in PubMed, Ovid, Google Scholar, EMBASE and Scielo. [3][4][5][6][7][8] Appendix intussusceptions due to endomentriosis and ileoileal intussuceptions have been more frequently reported. Considering all this, we conclude that our case is exceptional because it constitutes only the 14th reported case in which a cecal endometriotic mass triggered an ileocolic intussusception, and no other published cases have reported such a long intussusception, extending beyond splenic flexure.…”