ILEAL ENDOMETRIOSIS – A RARE CAUSE OF BOWEL OBSTRUCTION

Abstract

Endometriosis consists in the development of endometrial tissue outside the uterine cavity. Among the digestive segments, the most frequently affected by endometriosis are the recto-sigmoid, followed by the ascending colon, the small intestine and the appendix. Intestinal occlusion due to endometriosis represents 0.1-0.7% of all cases of intestinal occlusion. We report the case of a woman that presented with acute bowel obstruction due to ileal endometriosis. The patient was diagnosed and admitted at University Emergency Hospital Bucharest and has been prospectively followed since June 2022 and data included in the current report has been collected up to December 2022.

The patient was a 35-year-old, non-smoker, nuliparous, female, without a significant medical history, that presented to the emergency room accusing diffuse abdominal pain, nausea and vomiting, symptoms that have been evolving for approximately 24 hours and progressively worsened. The patient denied the use of oral contraceptive drugs or other medication. Right ileo-hemicolectomy with end-to-end ileo-colonic anastomosis and right ovary biopsy is performed. The histopathological analysis indicates the presence of endometriosis foci both at the level of the enteral resection segment and at the level of the biopsied right ovary. Intestinal occlusion due to endometriosis is a rare condition. It can take by surprise the clinician in the emergency room, but it is a valid diagnosis in case of a young women, with or without a previous diagnosis of endometriosis, with history of infertility or chronic pelvic pain, presenting with occlusive symptomatology, without any previous abdominal procedures. The intraoperative aspect of the lesions is frequently misleading due to the resemblance of the endometrial foci with cancerous masses.