Endometriosis: a rare cause of small bowel obstruction

• Published in: BMJ case reports Vol. 2012; no. aug09 1; p. bcr0320125988
• Main Authors: Khwaja, Samir A, Zakaria, Rasheed, Carneiro, Herman Anthony, Khwaja, Haris A
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 13.08.2012; BMJ Publishing Group
• Series: Reminder of important clinical lesson
• Subjects: Abdomen; Adult; Age; Appendix; Biopsy; Colectomy; Colonic Diseases - complications; Colonic Diseases - pathology; Colonic Diseases - surgery; Constriction, Pathologic - complications; Endometriosis; Endometriosis - complications; Endometriosis - pathology; Endometriosis - surgery; Europe (West); Family medical history; Female; Histopathology; Humans; Ileal Diseases - diagnostic imaging; Ileal Diseases - etiology; Ileal Diseases - surgery; Infertility; Inflammatory bowel disease; Intestinal Obstruction - diagnostic imaging; Intestinal Obstruction - etiology; Intestinal Obstruction - surgery; Intussusception - complications; Irritable bowel syndrome; Lymphatic system; Menstruation; Pain; Patients; Radiography; Reminder of Important Clinical Lesson; Ultrasonic imaging; White; Womens health
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr.03.2012.5988

Although endometriosis is a common condition in young women, symptomatic involvement of the small bowel is rare. The authors report the case of a 44-year-old lady initially thought to have irritable bowel syndrome who presented 1 month later with acute small bowel obstruction. A CT scan showed small bowel dilatation with a transition point in the ileum, but no distinct lesion. The patient had an exploratory laparotomy where an obstructing lesion in the terminal ileum and several enlarged mesenteric lymph nodes were identified. Consequently, a right hemicolectomy was performed. Pathology specimens showed multiple endometriotic foci in the bowel with stricturing of terminal ileum and appendiceal intussusception. This likely resulted in subocclusive episodes and intestinal obstruction. This case highlights the difficulty in establishing a preoperative diagnosis of endometriosis. Small bowel endometriosis should, therefore, be considered in the differential diagnosis of women of childbearing age who present with symptoms of obstruction.