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Gurluler E, Isik O, Ugras N, Sahin A, Sen M, Yilmazlar T. Intestinal endometriosis amongst other extra-pelvic endometriosis foci presenting as acute/subacute bowel obstruction in women of reproductive age: a retrospective case series study. BMC Surg 2025; 25:12. [PMID: 39773490 PMCID: PMC11706109 DOI: 10.1186/s12893-024-02755-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Accepted: 12/31/2024] [Indexed: 01/11/2025] Open
Abstract
BACKGROUND This study aimed to investigate the prevalence and clinicopathological correlates of intestinal endometriosis, amongst other extra-pelvic endometriosis foci, presenting as bowel obstruction in general surgery practice. METHODS A total of 23 female patients (mean ± SD age: 34.9 ± 6.5 years) who underwent abdominal surgery for acute bowel obstruction and received histopathological diagnosis of endometriosis were included in this retrospective case-series study. Data on patient characteristics, obstetric history, preoperative laboratory and imaging findings, preoperative provisional diagnosis, type of surgical intervention and the pathological diagnosis, and postoperative outcomes were recorded. RESULTS Definitive diagnoses on histopathological work-up involved intestinal endometriosis (52.2%), scar endometriosis (26.0%), ovarian endometriosis (13.0%) and inguinal endometriosis (8.7%). Postoperative complication, reoperation and recurrence rates were 8.7%, 8.7%, and 13.0%, respectively. Intestinal endometriosis, when compared to other extra-pelvic endometriosis foci (scar and inguinal), was associated with significantly higher preoperative platelet counts (332.0(284.0-528.0)vs. 239.0(223.0-370.0) 103/µL, p = 0.010), lower albumin levels (4.0(2.7-4.7) vs. 4.5(4.2-4.9) g/dL, p = 0.029), higher rates of preoperative CT utilization (91.7% vs. 0.0%, p < 0.001) and emergent surgery (83.3% vs. 0.0%, p = 0.001) and longer LOS (median 4.5 (1.0-26.0) vs. 1.0(1.0-1.0) days, p = 0.001) along with a non-significant tendency for higher postoperative complication (16.7% vs. 0.0%) and ICU stay (25.0% vs. 0.0%) rates. CONCLUSION Our findings revealed intestinal endometriosis, predominantly in the terminal ileum/appendix, was the most common extra-pelvic cause of acute bowel obstruction. The scar endometriosis, inguinal endometriosis and ovarian endometriosis appeared to be other potential but less prevalent aetiologies in this setting.
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Affiliation(s)
- Ercument Gurluler
- Department of General Surgery, Uludag University Faculty of Medicine, Bursa, Turkey.
- Department of General Surgery, Uludag University Faculty of Medicine, Bursa, Turkey.
| | - Ozgen Isik
- Department of General Surgery, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Nesrin Ugras
- Department of Pathology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Aysun Sahin
- Department of General Surgery, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Murat Sen
- Department of General Surgery, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Tuncay Yilmazlar
- Department of General Surgery, Uludag University Faculty of Medicine, Bursa, Turkey
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Kobayashi K, Yamadera M, Takeo H, Murayama M. Small bowel obstruction caused by appendiceal and ileal endometriosis: a case report. J Surg Case Rep 2022; 2022:rjac282. [PMID: 35721264 PMCID: PMC9200432 DOI: 10.1093/jscr/rjac282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Endometriosis is characterized by the presence of an ectopic endometrial gland. Intestinal endometriosis with small bowel obstruction is uncommon. In this case, a 37-year-old woman with no history of endometriosis presented with a chief complaint of abdominal pain. Computed tomography revealed a distal small bowel obstruction. Surgical intervention was performed because of the emergent abdominal condition and the potential resistance to conservative management. Histopathological examination revealed appendiceal and ileal endometriotic lesions. Preoperative diagnosis was difficult because there were no specific clinical features. Intraoperatively, it is difficult to distinguish intestinal endometriosis and bowel malignancy; thus, oncological resection should be performed.
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Affiliation(s)
- Kazuki Kobayashi
- Department of Surgery, Self-Defence Forces Central Hospital , Setagaya , Japan
| | - Masato Yamadera
- Department of Surgery, Self-Defence Forces Central Hospital , Setagaya , Japan
| | - Hiroaki Takeo
- Department of Diagnostic Pathology, Self-Defence Forces Central Hospital , Setagaya , Japan
| | - Michinori Murayama
- Department of Surgery, Self-Defence Forces Central Hospital , Setagaya , Japan
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3
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Mehmood S, Zhao S, Ain Q, Van Dellen J, Beggan C. Endometriosis of the Small Bowel: A Diagnostic Enigma. Cureus 2021; 13:e15520. [PMID: 34268046 PMCID: PMC8265278 DOI: 10.7759/cureus.15520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 11/21/2022] Open
Abstract
Endometriosis refers to the implantation and proliferation of endometrial tissue outside the uterus. Small bowel endometriosis is an uncommon location for endometrial deposits and when present, it can pose diagnostic difficulty. Here, we present a case of a 50-year-old female with small bowel endometriosis who suffered from recurrent attacks of colicky abdominal pain for few months. Her cross-sectional investigations remained largely inconclusive. Ultimately, she underwent diagnostic laparoscopy which was diagnostic and therapeutic.
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Affiliation(s)
- Saqib Mehmood
- General Surgery, Croydon University Hospital, London, GBR
| | - Sarah Zhao
- General Surgery, Croydon University Hospital, London, GBR
| | - Quratul Ain
- General Surgery, Croydon University Hospital, London, GBR
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Unmasking the great masqueraders: Concurrent isolated large cecal endometrioma and solitary extra-uterine retroperitoneal cellular leiomyoma - A case report with review of literature. Int J Surg Case Rep 2021; 80:105666. [PMID: 33636403 PMCID: PMC7918270 DOI: 10.1016/j.ijscr.2021.105666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/08/2021] [Accepted: 02/13/2021] [Indexed: 11/22/2022] Open
Abstract
Bowel involvement in endometriosis is rare. Cecal endometriosis is seen in just 3.5 % of patients with bowel involvement. Patients with bowel involvement typically also have associated ovarian &/or extra-ovarian pelvic endometriosis. This case is the rarest of rare cases in that the patient had isolated cecal endometriosis without any obvious pelvic disease. This is the largest reported size of a cecal endometrioma (8 × 6 cms), to the best of our knowledge. Extra-uterine cellular leiomyoma also known as ‘wandering fibroid’ & ‘parasitic leiomyoma’ is again an extremely rare neoplasm. There are very few reported cases of parasitic leiomyoma. Another rarest of rare event is the concurrent existence of the 2 above mentioned conditions in the same patient. Introduction Cecal endometriosis is an infrequent cause of right iliac fossa pain. The extra-uterine retroperitoneal cellular leiomyoma is a rare tumor. The concurrent existence of both these rare conditions is a unique event. Presentation of case We hereby report the case of a 44-year-old woman who had concurrent large isolated cecal endometrioma, which was diagnosed pre-operatively on imaging to be pelvic endometriosis/hematosalpinx and solitary retroperitoneal cellular leiomyoma, which was incidentally identified. Both the conditions were managed successfully by laparoscopy. Discussion Cecal endometriosis is difficult to diagnose pre-operatively as there are far commoner clinical conditions that cause similar signs and symptoms. Often it gets mistaken for these conditions and gets diagnosed incidentally ‘on table’ during surgeries being performed purportedly to treat them. Conclusion Although definitive diagnosis can only be obtained after histopathology, laparoscopy can be considered a standard diagnostic modality for both these conditions.
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Chiaffarino F, Cipriani S, Ricci E, Roncella E, Mauri PA, Parazzini F, Vercellini P. Endometriosis and inflammatory bowel disease: A systematic review of the literature. Eur J Obstet Gynecol Reprod Biol 2020; 252:246-251. [PMID: 32629225 DOI: 10.1016/j.ejogrb.2020.06.051] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 06/22/2020] [Accepted: 06/25/2020] [Indexed: 01/06/2023]
Abstract
The potential link between endometriosis and Inflammatory Bowel Disease (IBD) has been investigated over the last twenty years. Endometriosis shares with IBD features and symptoms so to become a significant diagnostic challenge, resulting in a delayed or indeterminate diagnosis. We conducted a systematic review to summarize the available data in literature on the co-diagnosis of IBD and endometriosis. A systematic literature search was performed using the electronic databases MEDLINE and EMBASE from 1990 to November 2019, using the search terms: inflammatory bowel disease OR ulcerative colitis OR Crohn's disease AND endometriosis. We selected 23 articles: 15 case-report, 3 clinical series, 3 case-control studies, 1 cross-sectional study and 1 cohort study. All the epidemiological studies included in this review reported a positive association between endometriosis and IBD. Meta-analysis was not possible because, due to study design and type of patients included, there were no comparable groups to analyze. In epidemiological studies with a control group, the proportion of IBD in patients with endometriosis varied from 2 to 3.4 %, compared to 0-1 % of the control group. A large nationwide Danish cohort study reported a 50 % increase in the risk of IBD in women with endometriosis in comparison with women in the general population. In a large Danish cohort study women with endometriosis had an increased risk of CD and UC with a standardized incidence ratio of 1.5 (95 % CI 1.3-1.7) and 1.6 (95 % CI 1.3-2.0) respectively. Several studies do not provide information on the temporal sequence of endometriosis and IBD and therefore a clear analysis of a cause-effect association between these two pathologies is lacking. The high number of case-reports in the literature highlights how the diagnosis can be challenged, as endometriosis can be masquerading as IBD or vice versa or be present within the same patient. Further research is needed to better understand the temporal association between endometriosis and IBD, which could be useful to correct evaluation and improve the management of these patients.
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Affiliation(s)
- Francesca Chiaffarino
- Department of Woman, Newborn and Child, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122, Milan, Italy.
| | - Sonia Cipriani
- Department of Woman, Newborn and Child, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122, Milan, Italy
| | - Elena Ricci
- Department of Woman, Newborn and Child, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122, Milan, Italy
| | - Elena Roncella
- Department of Clinical Sciences and Community Health, Università degli studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122, Milan, Italy
| | - Paola Agnese Mauri
- Department of Clinical Sciences and Community Health, Università degli studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122, Milan, Italy
| | - Fabio Parazzini
- Department of Woman, Newborn and Child, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122, Milan, Italy
| | - Paolo Vercellini
- Department of Woman, Newborn and Child, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122, Milan, Italy
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6
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Popivanov G, Stoyanova D, Fakirova A, Konakchieva M, Stefanov D, Kjossev K, Mutafchiyski V. Ileus caused by small bowel, ileocaecal and rectal endometriosis misdiagnosed as Crohn's disease and managed by synchronous ileocaecal and rectal resection. Ann R Coll Surg Engl 2020; 102:e205-e208. [PMID: 32538117 DOI: 10.1308/rcsann.2020.0118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The reported incidence of intestinal endometriosis varies between 22% and 37%, with bowel obstruction in only 2.3% of cases, but few series report acute obstruction. We report a rare case of acute bowel obstruction due to multiple bilateral deep intestinal endometriosis lesions localised in the ileum, ileocaecal valve and upper rectum, requiring synchronous resection in an emergency setting. A 42-year-old woman was referred to our clinic with a diagnosis of obstructing Crohn's disease based on abdominal computed tomography with oral contrast showing a thickened terminal ileum with stenosis, compression of the caecum and proximally dilated small bowel loops. Simultaneous ileocaecal resection and segmental resection of the upper rectum with handsewn end-to-end anastomosis between the sigmoid colon and rectum was performed. Owing to the advanced bowel obstruction and significant weight loss, a double barrelled ileoascendostomy was created. The patient had an uneventful recovery. Histological examination revealed transmural endometriosis with involvement of the pericolic fat in both specimens. Although intestinal endometriosis causing acute bowel obstruction is rare, it should be included among the differential diagnoses in young women with recurrent abdominal pain, intermittent diarrhoea and constipation without a family history for inflammatory bowel disease or cancer. Bleeding synchronous with menstruation is not typical for intestinal endometriosis. Right-sided intestinal endometriosis more frequently causes acute bowel obstruction, in most cases due to intussusception.
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Affiliation(s)
| | | | - A Fakirova
- Military Medical Academy, Sofia, Bulgaria
| | | | - D Stefanov
- Military Medical Academy, Sofia, Bulgaria
| | - K Kjossev
- Military Medical Academy, Sofia, Bulgaria
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Choi JDW, Yunaev M. Endometriosis of the appendix causing small bowel obstruction in a virgin abdomen. BMJ Case Rep 2019; 12:12/7/e230496. [PMID: 31337629 DOI: 10.1136/bcr-2019-230496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
A 29-year-old, otherwise well, nulligravid woman presented to the emergency department with 1-day history of generalised abdominal pain and vomiting. She had similar symptoms 6 months prior following recent menstruations, which resolved conservatively. She had no prior history of abdominal surgery or endometriosis. CT scan demonstrated distal small bowel obstruction. A congenital band adhesion was suspected, and she underwent prompt surgical intervention. During laparoscopy, a thickened appendix was adhered to a segment of distal ileum. There was blood in the pelvis. Laparoscopic adhesiolysis and appendicectomy were performed. Histopathology demonstrated multiple foci of endometriosis of the appendix with endometrial glands surrounded by endometrial stroma. Oestrogen receptor and CD10 immunostains highlighted the endometriotic foci. The patient made a good recovery and was referred to a gynaecologist for further management.
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Affiliation(s)
- Joseph Do Woong Choi
- Department of Surgery, Norwest Private Hospital, Sydney, New South Wales, Australia
| | - Michael Yunaev
- Department of Surgery, Norwest Private Hospital, Sydney, New South Wales, Australia
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Viganò L, Mineccia M, Bertolino F, Giraldi F, Rigazio C, Rocca R, Ferrero A. Intraoperative ultrasonography in patients undergoing surgery for Crohn's disease. Prospective evaluation of an innovative approach to optimize staging and treatment planning. Updates Surg 2019; 71:305-312. [PMID: 31254233 DOI: 10.1007/s13304-019-00668-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 06/22/2019] [Indexed: 01/04/2023]
Abstract
Percutaneous ultrasonography (perc-US) and magnetic resonance enterography (e-MR) are the present standards for staging patients with Crohn's disease (CD). However, intraoperative data still have some discrepancies with preoperative ones. The contribution of intraoperative ultrasonography (IOUS) has never been evaluated. Sixty-five consecutive patients scheduled for ileal/colonic resection for CD between 2010 and 2014 were prospectively enrolled. All patients had perc-US, e-MR and IOUS. Data from different imaging modalities were compared. The reference standard was the final pathology. Surgery was scheduled because of intestinal obstruction (n = 31 patients), inflammatory mass (n = 21), fistula (n = 10), or abdominal pain/sepsis (n = 3). Fourteen (21.5%) patients had a major discrepancy between preoperative and intraoperative data that required a modification of the surgical planning (five additional ileal lesions, three unknown ileo-sigmoid fistulas, and six not confirmed CD sites). IOUS correctly staged CD in all but one patients (missed ileo-colonic fistula). Pathology data differed from Perc-US data in 13 (20%) patients, from e-MR data in 14 (21.5%), and from IOUS data in one (1.5%). The sensitivity of Perc-US, e-MR and IOUS was: for the identification of CD sites 84.2%, 86.1%, and 100%; for the identification of stenoses 86.8%, 86.8%, and 100%; for the identification of fistulas 75.0%, 81.3%, and 93.8%, respectively. IOUS contributed to the surgical planning in 8 (12.3%) patients. IOUS is a safe, feasible and easy-to-perform procedure that optimizes staging of CD and, in some patients, helps to better define the treatment strategy. It could be helpful to face complex disease presentations on the basis of objective and reproducible data.
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Affiliation(s)
- Luca Viganò
- Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Clinical and Research Center, IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy.
| | - Michela Mineccia
- Department of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Turin, Italy
| | - Franco Bertolino
- Department of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Turin, Italy
- Department of General Surgery, Ospedale Savigliano ASL CN1, Savigliano, Italy
| | - Francesco Giraldi
- Department of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Turin, Italy
| | - Caterina Rigazio
- Department of Gastroenterology, Ospedale Mauriziano Umberto I, Turin, Italy
| | - Rodolfo Rocca
- Department of Gastroenterology, Ospedale Mauriziano Umberto I, Turin, Italy
| | - Alessandro Ferrero
- Department of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Turin, Italy
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Bacalbasa N, Balescu I, Filipescu A. Ileocecal Obstruction Due to Endometriosis - A Case Report and Literature Review. In Vivo 2017; 31:999-1002. [PMID: 28882972 PMCID: PMC5656879 DOI: 10.21873/invivo.11160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 08/08/2017] [Accepted: 08/09/2017] [Indexed: 12/29/2022]
Abstract
Endometriosis is a common finding in premenopausal women and a significant number of cases presenting digestive tract involvement at the time of diagnosis. However, most of these patients present pelvic nodules involving the rectosigmoidian junction, other digestive tract segments being less commonly affected. We present the case of a 37-year-old nulliparous woman who presented for diffuse abdominal pain and vomiting; she was diagnosed with complete ileocecal obstruction due to an endometriosis nodule in association with bilateral ovarian endometriosis lesions invading the rectosigmodian wall. A right colectomy with ileocolic anastomosis in association with bilateral cystectomy and rectosigmodian resection was successfully performed. The histopathological examination confirmed the endometriosic origin of the nodules invading the rectosigmodian and ileocecal wall, that was similar to the one described at the level of the ovarian cysts.
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Affiliation(s)
- Nicolae Bacalbasa
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Alexandru Filipescu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- "Elias" Emergency University Hospital, Bucharest, Romania
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López Carrasco A, Hernández Gutiérrez A, Hidalgo Gutiérrez PA, Rodríguez González R, Marijuán Martín JL, Zapardiel I, de Santiago García J. Ileocecal endometriosis: diagnosis and management. Taiwan J Obstet Gynecol 2017; 56:243-246. [DOI: 10.1016/j.tjog.2016.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2016] [Indexed: 02/07/2023] Open
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Torralba-Morón A, Urbanowicz M, Ibarrola-De Andres C, Lopez-Alonso G, Colina-Ruizdelgado F, Guerra-Vales JM. 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. Intern Med 2016; 55:2595-9. [PMID: 27629952 DOI: 10.2169/internalmedicine.55.6461] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
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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Abstract
BACKGROUND Inflammatory bowel disease (IBD) and endometriosis are immune-mediated chronic inflammatory disorders affecting young women. The clinical significance of concomitant endometriosis on the course of IBD has not been previously studied. The aim of this study was to determine whether women with concomitant endometriosis and IBD have a unique phenotype and worse prognosis of IBD. METHODS This was a case-control study performed at a tertiary referral center. Cases were women with diagnoses of both endometriosis and IBD. Two random IBD controls without endometriosis were selected for each case, frequency matched for age and IBD type, Crohn's disease (CD) or ulcerative colitis. Primary outcomes included disease phenotype; the use of immunomodulators, antiTNF agents, or combination therapy and the need for IBD-related surgery. RESULTS We identified 51 cases with endometriosis and IBD (28 CD, 23 ulcerative colitis). There was no difference in race, age at IBD diagnosis, and mean duration of IBD between endometriosis-IBD cases and controls. Among endometriosis-CD patients whose endometriosis was surgically verified, there was a higher risk for stricturing disease compared with CD controls (odds ratio, 11.8; 95% confidence interval, 2.03-69.0). There was no difference in phenotype in endometriosis-ulcerative colitis patients. There were no significant differences in IBD-related medication use or surgeries overall or when stratified by IBD type. CONCLUSIONS Patients with CD and endometriosis, which was surgically diagnosed, were more likely to have stricturing CD. Concomitant endometriosis did not impact the natural history of IBD.
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13
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Endometriosis and Crohn's Disease Side by Side: A Case Report. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2016. [DOI: 10.5301/je.5000233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Endometriosis is the presence of ectopic endometrial tissue at extrauterine sites. Symptoms vary greatly and depend on the extent of the disease, ranging from an asymptomatic state to a miscellaneous group of symptoms. The correct diagnosis of intestinal endometriosis is often delayed because it may clinically masquerade as a wide spectrum of diseases, mainly Crohn's disease. We describe the case of a 42-year-old woman who presented to our hospital with subacute bowel obstruction. She had been suffering from strong abdominal disorders for over ten years with recurrent abdominal pain and chronic diarrhea, sometimes with gross bleeding, resulting in impaired nutrition, weight loss, and several hospital admissions. She had been diagnosed with Crohn's Disease ten years earlier, which was established by imaging, endoscopic and histologic criteria. The gastrointestinal symptoms were recurrent despite the medication for inflammatory bowel disease (IBD). The patient underwent a laparotomy, which identified a large bowel wall thickening with severe mucosal edema and luminal stricture in the proximal ileum. An ileocecal resection and appendectomy with latero-lateral ileocolic anastomosis was performed. Histopathological examination reported a diagnosis of ileocecal endometriosis. After a three-year follow-up period, she has no gynecologic symptoms but still maintains chronic diarrhea and imaging and endoscopic criteria are suggestive of IBD. Intestinal endometriosis should be borne in mind when a woman of reproductive age presents with episodic gastrointestinal symptoms. Multidisciplinary care should be encouraged.
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Endometriosis mimicking symptoms of microperforation in a teenage girl with inflammatory bowel disease. J Pediatr Gastroenterol Nutr 2014; 59:e27-9. [PMID: 23575301 DOI: 10.1097/mpg.0b013e3182952f04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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15
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Tong YL, Chen Y, Zhu SY. Ileocecal endometriosis and a diagnosis dilemma: A case report and literature review. World J Gastroenterol 2013; 19:3707-3710. [PMID: 23801877 PMCID: PMC3691027 DOI: 10.3748/wjg.v19.i23.3707] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 03/20/2013] [Accepted: 04/28/2013] [Indexed: 02/06/2023] Open
Abstract
Bowel endometriosis affects between 3.8% and 37% of women with endometriosis. The evaluation of symptoms and clinical examination are inadequate for an accurate diagnosis of intestinal endometriosis. We describe the case of a 41-year-old woman who presented to our hospital because of six months of recurrent abdominal pain, vomiting and diarrhea, without previous history of bowel disease. Physical examination revealed a palpable 3 cm × 5 cm mass in the right lower quadrant abdomen. Laboratory tests showed slightly elevated levels of CA19-9 and CA125. Small bowel computer tomography scanning revealed an ileocecal mass with bowel wall thickening and luminal narrowing. Small bowel endoscopy identified a deep longitudinal ulcer and mucosal edema in the distal ileum. All these findings supported the diagnosis of Crohn’s disease. The patient underwent a laparotomy, which identified a 5 cm × 5 cm ileocecal mass with severe mucosal edema and luminal stricture in the distal ileum. Histopathological examination confirmed a diagnosis of ileocecal endometriosis without other areas involved. After one-year follow-up, there was no recurrence of the symptoms.
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Upreti S, Bansal R, Upreti S, Mathur S. Stromal endometriosis of the intestine: an elusive presentation with a review of the literature: a case report. J Clin Diagn Res 2013; 7:378-80. [PMID: 23543811 DOI: 10.7860/jcdr/2013/5075.2775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 12/05/2012] [Indexed: 01/07/2023]
Abstract
Although endometriosis involves the small intestine only rarely, when present, this condition may simulate a variety of inflammatory and sometimes neoplastic conditions because of its nonspecific symptoms. We are reporting here, a case of ileal, caecal and appendiceal endometriosis which presented in the emergency as a case of an acute intestinal obstruction with a long history of symptoms which were referable to the GI tract. The patient had the diffuse involvement of a segment of the ileum with mural thickening and luminal narrowing, which led to obstruction. The literature on small bowel endometriosis has been reviewed and the clinical and pathological features have been discussed.
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Endometriosis of the terminal ileum: a diagnostic dilemma. Case Rep Pathol 2012; 2012:742035. [PMID: 22997597 PMCID: PMC3446655 DOI: 10.1155/2012/742035] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 08/21/2012] [Indexed: 12/15/2022] Open
Abstract
Endometriosis is characterized by the presence of endometrial tissue consisting of glands and/or stroma located outside the uterus. Involvement of the terminal ileum is extremely rare. Preoperative distinction of ileal endometriosis from other diseases of the ileocecal region is difficult in terms of clinical presentation, symptomatology, radiological appearance, and surgical and pathological findings. We report a case initially diagnosed as Crohn's disease due to a longstanding diarrhea with subsequent intestinal obstruction, but finally diagnosed as ileal endometriosis by histopathological evaluation after resection of the involved segment.
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Montalto M, Santoro L, D'Onofrio F, Gallo A, Campo S, Campo V, Gasbarrini A, Gasbarrini G. Endometriosis, need for a multidisciplinary clinical setting: the internist's point of view. Intern Emerg Med 2010; 5:463-7. [PMID: 20449690 DOI: 10.1007/s11739-010-0404-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Accepted: 04/13/2010] [Indexed: 01/07/2023]
Abstract
Endometriosis is a common condition characterized by proliferation of endometrial tissue outside the uterus, both in the pelvis and in other extra-pelvic sites. The clinical picture of endometriosis is widely heterogeneous. A correct diagnostic work-up of these patients can sometimes be very difficult, since there are a number of gynecological, intestinal and systemic diseases mimicking endometriosis, as well as other conditions that could be associated with or are a consequence of this disorder. Therefore, multidisciplinary care should be encouraged to ensure correct evaluation and improve the management of these patients.
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Affiliation(s)
- Massimo Montalto
- Institute of Internal Medicine, Catholic University, Largo Agostino Gemelli 8, 00168 Rome, Italy.
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Slesser AA, Sultan S, Kubba F, Sellu DP. Acute small bowel obstruction secondary to intestinal endometriosis, an elusive condition: a case report. World J Emerg Surg 2010; 5:27. [PMID: 20846366 PMCID: PMC2949747 DOI: 10.1186/1749-7922-5-27] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2010] [Accepted: 09/16/2010] [Indexed: 12/19/2022] Open
Abstract
Background Endometriosis is a benign condition affecting females of reproductive age. Although intestinal endometriosis is common it is rare for the condition to manifest as an acute bowel obstruction secondary to ileocaecal and appendicular endometriosis. This case is important to report as it highlights the diagnostic difficulty this particular condition presents to an emergency surgeon. Case presentation We present the case of a 33 year old female of Asian origin who presented with symptoms and signs of an acute small bowel obstruction. A right hemicolectomy for suspected malignancy was performed with an ileocolic anastomosis. Histological examination demonstrated extensive endometriosis of the appendix and ileocaecal junction. Conclusion Enteric endometriosis should be considered as a differential diagnosis when assessing females of reproductive age with acute small bowel obstruction. A high index of suspicion is required to arrive at a diagnosis of this elusive condition.
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Affiliation(s)
- Alistair Ap Slesser
- Department of Surgery, Ealing Hospital, Uxbridge Road, Southall, Middlesex, UK.
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