Endometriosis of the Terminal Ileum: A Diagnostic Dilemma

Karaman, Kerem; Pala, Emel Ebru; Bayol, Ümit; Akman, Özlem; Ölmez, Mustafa; Unluoglu, Saime; Öztürk, Şafak

doi:10.1155/2012/742035

Cited by 25 publications

(37 citation statements)

References 17 publications

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“…Imaging studies, such as multislice CT (especially if combined with enteroclysis), MRI, endoscopic ultrasound, and transvaginal sonography have a great potential for detecting alterations in the intestinal wall. Colonoscopy has not proved helpful in diagnosis, as in our case, but it is still recommended in all patients with suspected endometriosis to rule out mucosal involvement and malignant lesions [8]. Despite this array of investigational methods, laparoscopy remains the only investigation able to confirm the presence of intestinal endometriosis [1,4].…”

Section: Discussionmentioning

confidence: 71%

A rare case of sigmoid colon obstruction in patient with ulcerative colitis: role of transabdominal ultrasound-guided biopsy

et al. 2014

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Introduction Endometriosis is a common chronic gynaecological disease affecting 10 % of women of reproductive age. Of these 5-12 % may present bowel endometriosis that may be asymptomatic or associated with aspecific symptoms even bowel obstruction. Case presentation The case of a 41-year-old woman with history of ulcerative colitis, previous diagnosis of ovarian endometriosis, recurrent abdominal pain not related to the menstrual cycle, with abdominal pain and obstinate constipation for 2 weeks was referred. The patient underwent colonoscopy, transabdominal ultrasound and ultrasoundguided fine-needle biopsy to have a diagnosis. Discussion Endometriosis should be considered in the differential diagnosis of every woman of childbearing age who presents with gastrointestinal or abdominal symptoms. As demonstrated in our case and by the burgeoning literature in this field, we believe that the role of transabdominal ultrasound should be reconsidered in the management of abdominal diseases because this examination associated with ultrasound-guided fine-needle biopsy allows, in expert hands, to obtain adequate histological samples avoiding patients to undergo more invasive tests to get a diagnosis.Keywords Transabdominal ultrasound Á Ultrasoundguided fine-needle biopsy Á Intestinal endometriosis Á Bowel obstruction Riassunto Introduzione L'endometriosi è una malattia ginecologica cronica comune che colpisce il 10 % delle donne in età riproduttiva. Nel 5-12 % si può presentare una localizzazione intestinale della malattia. Essa può presentarsi in svariati modi potendo essere asintomatica o potendosi manifestare con sintomi aspecifici includendo perfino l'occlusione intestinale. Caso clinico presentiamo il caso di una donna di 41 anni affetta da colite ulcerosa, con storia di precedente diagnosi di endometriosi ovarica e ricorrenti dolori addominali non correlati al ciclo mestruale. Riferisce da circa due settimane il peggioramento dei dolori addominali cui si associa stipsi ostinata. È stata quindi sottoposta a colonscopia, ecografia transaddominale e biopsia ecoguidata per via transaddominale prima di poter fare una diagnosi. Discussione L'endometriosi dovrebbe essere considerata nella diagnosi differenziale in ogni donna in età fertile che si presenta con sintomi gastrointestinali o addominali vaghi. Come nel caso clinico illustrato e alla luce della fiorente letteratura in questo campo, riteniamo che il ruolo dell'ecografia transaddominale dovrebbe essere riconsiderato nella gestione delle malattie addominali. Infatti, l'ecografia transaddominale associata alla possibilità di poter eseguire in corso dello stesso esame una biopsia ecoguidata, permetterebbe di poter ottenere un adeguato campione istologico evitando al paziente esami più invasivi per raggiungere una diagnosi.

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Section: Discussionmentioning

confidence: 71%

A rare case of sigmoid colon obstruction in patient with ulcerative colitis: role of transabdominal ultrasound-guided biopsy

et al. 2014

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“…Endometriosis has a predilection to obstruct the terminal ileum. We identify 12 case reports of acute small bowel obstruction in the literature (1,3,6,7,9,(11)(12)(13)(14). Our report describes two additional cases.…”

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

“…The mucosa is only affected in approximately 10% of previously described cases (2,5,6,13), showing different features such as architectural distortion, chronic inflammatory infiltrate, ulcers, strictures and fistulas, which can be mistaken for Crohn's disease. In the literature search, we found out that a preoperative diagnosis of Crohn's disease was made in 14 case reports (3,6,7,10,14,16), and we similarly initially suspected Crohn's disease in our first case. In some previously reported cases, there was a coexistence of both diseases (16); although the presence of a source of intestinal endometriosis presumably causes a weakness in the affected region of the intestinal wall, in other cases the ischemic and inflammatory events were secondary to endometriosis (2,7,14).…”

Section: Discussionmentioning

confidence: 99%

“…However, intestinal endometriosis is a rare condition, affecting between 3-37% of all cases of endometriosis (2)(3)(4). The most common location of intestinal endometriosis is the rectosigmoid area (50-90%), followed by rectovaginal septum (13%), small bowel (7%), appendix (3-18 %), caecum (4%) and Meckel's diverticulum (2 cases described in the literature) (2)(3)(4)(5)(6). In the small bowel, the terminal ileum has the propensity to host the lesion, because it is in the vicinity of the fallopian tubes and ovary (4).…”

Section: Introductionmentioning

confidence: 99%

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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

et al. 2016

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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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