Nongynecological endometriosis presenting as an acute abdomen

Abstract

Endometriosis is a highly prevalent disease that affects up to 10 % of menstruating women. Patients commonly present with pelvic pain or infertility, although the range of clinical symptoms varies widely. Affected women may be asymptomatic or experience mild, moderate, or severe pain that fluctuates with hormonal cycles. Patients who suffer extreme pain may seek immediate care and present to the emergency department with clinical signs of an acute abdomen. In the case of patients without a prior history of endometriosis, the differential diagnosis is broad and making the correct clinical and radiologic diagnosis in the emergency setting can be challenging. In some cases, the diagnosis is only made after surgical or histopathological analysis. Prompt and accurate clinical and radiological evaluation is necessary because complications of endometriosis, such as bowel obstruction and appendicitis, may require immediate surgical intervention. This pictorial essay analyzes nongynecological manifestations of endometriosis that may have a clinical presentation of an acute abdominal emergency. Atypical clinical presentations and unusual sites and complications of endometriosis are discussed, as well as the differential diagnostic considerations. The radiologic features of endometriosis are shown on multiple modalities, including computed tomography, magnetic resonance imaging, and ultrasound.

A case report of endometriosis presenting as an acute small bowel obstruction

“…Ultrasound is the most common modality for initial imaging for endometriosis in the subacute setting. In the acute setting in symptomatic patients, CT imaging can aid clinical management [8] . Endometrial masses can appear as cystic, solid or mixed on CT imaging.…”

Endometriosis of the appendix

“…However, the CT findings for endometriosis are almost always nonspecific and are usually not evident in imaging studies [1]. Abdomen ultrasonography can be considered for patients who cannot receive APCT.…”

“…It is a highly prevalent disease that affects up to 10% of menstruating women, approximately 70% of women with chronic pelvic pain, and up to 50% of women with infertility [1]. …”

“…Symptomatic women have mild to severe pain that may or may not be cyclic depending on the site involved and severity of the disease. Endometriosis most often causes chronic pelvic pain; however, women may suffer acute abdominal or pelvic pain severe enough to cause them to seek emergency medical care [1]. …”

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“…L'autre diagnostic plausible était celui d'une endométriose en raison du début des symptômes au cours des menstruations, du syndrome algique pelvien ainsi que des douleurs diffuses notamment aux membres inférieurs pouvant se voir dans les formes atypiques d'endométriose. De plus, la présence d'une douleur abdominale aiguë avec parfois un abdomen pseudo-chirurgical est possible dans l'endométriose [2]. Enfin, la présence de troubles bipolaire semble être plus fréquente chez les femmes atteintes d'endométrioses [3].…”