Case Report
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World J Gastroenterol. Jul 21, 2013; 19(27): 4413-4417
Published online Jul 21, 2013. doi: 10.3748/wjg.v19.i27.4413
Coincidence of active Crohn's disease and florid endometriosis in the terminal ileum: A case report
Elke Kaemmerer, Maren Westerkamp, Reinhard Kasperk, Gerhard Niepmann, Axel Scherer, Nikolaus Gassler
Elke Kaemmerer, Department of Pediatrics and Institute of Pathology, RWTH Aachen University, D-52074 Aachen, Germany
Maren Westerkamp, Reinhard Kasperk, Gerhard Niepmann, Department of Surgery, Luisenhospital Aachen, D-52064 Aachen, Germany
Axel Scherer, Department of Radiology, Luisenhospital Aachen, D-52064 Aachen, Germany
Nikolaus Gassler, Institute of Pathology, RWTH Aachen University, D-52074 Aachen, Germany
Author contributions: Kaemmerer E, Westerkamp M and Gassler N designed and wrote the report; Westerkamp M, Kasperk R and Niepmann G were attending doctors for the patient and performed surgical operation; Scherer A performed image diagnosis; Gassler N performed pathological examination.
Supported by The Rotationsprogramm of the Medical Faculty RWTH Aachen to Kaemmerer E
Correspondence to: Nikolaus Gassler, MA, Professor, Institute of Pathology, RWTH Aachen University, Pauwelsstrasse 30, D-52074 Aachen, Germany. ngassler@ukaachen.de
Telephone: +49-241-8088897 Fax: +49-241-8082548
Received: January 4, 2013
Revised: March 15, 2013
Accepted: April 27, 2013
Published online: July 21, 2013
Processing time: 194 Days and 16.3 Hours
Abstract

Crohn’s disease (CD), a variant of chronic inflammatory bowel disease, frequently affects the terminal ileum and coecal region. The clinical symptoms are often subtle and depend on the inflammatory activity of disease. In women of child-bearing age, florid intestinal endometriosis can simulate CD. Moreover, current pathophysiological concepts include intestinal endometriosis as a putative founder lesion for consecutive CD establishment. The report summarizes clinical and histomorphological data of a 35-year-old woman with the rare coincidence of florid intestinal endometriosis and CD both affecting the terminal ileum. The patient was suffering over 10 years from strong abdominal disorders including constipation, diarrhea, weight loss, and diffuse abdominal pain. In magnetic resonance imaging-Sellink, strong inflammation and intestinal obstruction of the terminal ileum were found. The laparoscopy revealed further evidence for existence of an inflammatory disease like CD, but brownish spots on the peritoneum were found indicative for endometriosis. Surgical resection of the terminal ileum and the coecal segment was performed followed by histopathological investigations. In transmural sections of the terminal ileum, histomorphological features of florid endometriosis intermingled with florid CD was found. The diagnostic findings were substantiated with a panel of immunohistological stainings. In conclusion, the findings demonstrate that florid endometriosis persists in florid CD lesions and the putative link between intestinal endometriosis and CD is more complex than previously assumed.

Keywords: Crohn’s diseases; Intestinal endometriosis; Pathogenesis

Core tip: A 35-year-old woman with the rare constellation of a strong mixture of florid intestinal endometriosis and Crohn’s disease in the terminal ileum is presented. Our findings suggest that there exist a putative link between the pathogenesis of both entities, which is more complex than previously assumed.