Small Bowel Obstruction Caused by Ileal Endometriosis with Appendiceal and Lymph Node Involvement Treated with Single-Incision Laparoscopic Surgery: A Case Report and Review of the Literature

Abstract

Patient: Female, 40-year-old Final Diagnosis: Intestinal endometriosis Symptoms: Abdominal pain Medication:— Clinical Procedure: — Specialty: Surgery Objective: Challenging differential diagnosis Background: Endometriosis is an ectopic proliferation of endometrial glands and interstitium outside the uterus. It usually affects the organs surrounding the uterus, and less often, involvement of extrapelvic organs, such as the intestines and urinary tract, is observed. Case Report: A 40-year-old woman had been experiencing intermittent right lower abdominal pain for years, which worsened months earlier. The patient was admitted for the worst pain ever accompanying nausea and vomiting. Contrast-enhanced computed tomography revealed a heterogeneously enhanced lesion that measured approximately 50×25×35 mm, and a caliber change of the ileum at the same site with dilated small bowel proximal to the caliber change were observed. Colonoscopy revealed that the ileocecal valve and the lumen of the terminal ileum protruded inward, suggesting an extramural compression by the lesion. Since the patient showed no improvement following conservative therapy, bowel resection through a single-incision laparoscopic surgery was successfully performed. Histopathological exploration showed patchy infiltration of endometrium-like tissues in the muscularis propria and subserosa layers of the ileum and appendix. Moreover, nearby lymph nodes resected for their firmness showed similar findings. Conclusions: We report a case of recurrent intestinal obstruction due to ileal and appendiceal endometriosis with lymph node involvement, which was successfully treated by single-incision laparoscopic surgery. Careful follow-up is important because the prognosis for the intestinal endometriosis with lymph node involvement is still unclear.

Beyond borders: A case report of small bowel obstruction secondary to undiagnosed florid endometriosis

“…Endometriosis is a chronic inflammatory, estrogen-dependent condition that can be divided into genital versus extra-genital with the bowel being the most common location for extra-genital endometriosis [1] , [2] , [3] .…”

“…Endometriosis of the bowel accounts for 10% of cases with the majority involving the rectum and sigmoid (80–90%). It typically presents as a single nodule, with a diameter greater than 1 cm, commonly infiltrating the muscularis layer of the bowel and the surrounding structures [1] , [2] , [3] .…”

“…Clinical symptoms, examination, biological tests and imaging modalities are all non-specific in diagnosing endometriosis and therefore careful consideration should be given to rule out endometriosis in young female patients with chronic abdominal symptoms [1] , [2] , [3] . Clinical presentation of endometriosis is highly variable according to the organ affected.…”

“…Clinical presentation of endometriosis is highly variable according to the organ affected. The most common presentation when terminal ileum/appendix is affected is bowel obstruction, perforation, acute appendicitis and intussusception [3] .…”

Rare Case of Ileocecal Obstruction Secondary to Endometriosis Presenting for the First Time

“…Intestinal obstruction at the ileocecal region is most commonly caused by aetiologies like tuberculosis, Crohn's disease, malignancy including lymphomas, radiation enteritis, or adhesions. Though endometriosis involving the intestines is known, these causing ileocecal obstruction is a rare presentation and is found only as case reports [1][2][3][4]. Endometriosis is the presence of endometrial-type mucosa outside the uterine cavity.…”