Title:Bowel obstruction secondary to deepinfiltrating endometriosis of the ileum
Authors:Marco Antonio Ávila Vergara, VioletaSánchez Carrillo, Felipe Peraza Garay
DOI: 10.17235/reed.2018.5364/2017Link: PubMed (Epub ahead of print)
Please cite this article as:Ávila Vergara Marco Antonio, SánchezCarrillo Violeta, Peraza Garay Felipe. Bowelobstruction secondary to deep infiltratingendometriosis of the ileum . Rev EspEnferm Dig 2018. doi:10.17235/reed.2018.5364/2017.
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CE 5364 inglés
Bowel obstruction secondary to deep infiltrating endometriosis of the ileum
Marco Antonio Ávila-Vergara1,2, Violeta Sánchez-Carrillo3 and Felipe Peraza-Garay4
1Department of Gynecology. Hospital General Regional No. 1. Instituto Mexicano del
Seguro Social. Culiacán, Sinaloa. Mexico. 2Medicine Faculty. Universidad Autónoma de
Sinaloa. Culiacán, Sinaloa. Mexico. 3Department of Gynecology and Obstetrics.
Coordinación Universitaria del Hospital Civil de Culiacán. Universidad Autónoma de
Sinaloa. Culiacán, Sinaloa. Mexico. 4Research and Teaching in Health Sciences Center.
Universidad Autónoma de Sinaloa. Culiacán, Sinaloa. Mexico
Correspondence: Marco Antonio Ávila Vergara
e-mail: [email protected]
Key words: Deep infiltrating endometriosis. Inflammatory bowel syndrome. Ileal
obstruction. Ileum.
Dear Editor,
Deep infiltrating endometriosis (DIE) of the ileum is an uncommon lesion that may have a
severe clinical presentation. Diagnosis is challenging in the absence of a gynecological
history of endometriosis and due to the anatomical location (1). We read the article by
Sánchez, Candel, and Albarracín (2) and would like to report an additional case that was
managed urgently.
Case report
The case was a 41-year-old female who presented to the Emergency Room (ER) due to
acute abdominal pain. She had a history of irritable bowel syndrome. On admission, the
patient was conscious, well oriented, with mild mucosal dehydration. The vital signs were
normal and there were no respiratory complications. She had abdominal tenderness on
deep palpation and the abdomen was distended with tympanites and increased
peristalsis. The pelvic ultrasound was normal. Small-bowel loops and the stomach were
dilated, with a reduced caliber area at the terminal ileum. An emergency exploratory
laparotomy (ELAP) was performed, which revealed lax interloop adhesions and an ileal
growth of 2.5 cm in diameter that occluded 90% of the intestinal lumen at 6 cm from the
ileocecal valve. A segmental resection of the terminal ileum, cecal appendix and ascending
colon, with a partial omentectomy and side-to-side ileotransversal anastomosis, was
performed. The outcome was uneventful. The histopathology analysis identified deep
infiltrating endometriosis of the ileum (Fig. 1). The tumor markers were as follows: CA125
of 212 and CAE of 3 ng/ml. A single subcutaneous dose of goserelin acetate at 10.8 mg
was prescribed. After two months, the CA125 levels were 22.
Discussion
The diagnostic difficulty associated with ileal DIE has been extensively reported (3,4).
Most patients experience mild symptoms in the long-term, although intestinal
complications may occur. Furthermore, endoscopic findings may mimic other
inflammatory bowel conditions. In cases with no mucosal involvement, the differential
diagnosis should include carcinoma and inflammatory bowel disease (5).
In contrast with the series reported by Sánchez et al., no endometriosis lesions were
found in the peritoneum.
Acknowledgements
We are grateful to Dr. Jaime Moya Núñez for his contribution to the histopathological
diagnosis and to Dr. Jaime Alberto Sánchez Cuen and Dr. Gerardo Arturo Reyes
Moctezuma for their review of the paper. Medicine Faculty, Universidad Autónoma de
Sinaloa, Culiacán, Sinaloa, Mexico.
References
1. Fedele L, Berlanda N, Corsi C, et al. Ileocecal endometriosis: Clinical and
pathogenetic implications of an underdiagnosed condition. Fertil Steril 2014;101(3):750-3.
DOI: 10.1016/j.fertnstert.2013.11.126
2. Sánchez Cifuentes Á, Candel Arenas MF, Albarracín Marín-Blázquez A, et al.
Intestinal endometriosis. Our experience. Rev Esp Enferm Dig 2016;108(8):524-5. DOI:
10.17235/reed.2016.4292/2016
3. Seaman H, Ballard K, Wright J, et al. Endometriosis and its coexistence with
irritable bowel syndrome and pelvic inflammatory disease: Findings from a national case -
Control study. Part 2. BJOG 2008;115:1392-6. DOI: 10.1111/j.1471-0528.2008.01879.x
4. De Cicco C, Corona R, Schonman R, et al. Bowel resection for deep endometriosis:
A systematic review. BJOG 2011;118:285-91. DOI: 10.1111/j.1471-0528.2010.02744.x
5. Jiang W, Roma AA, Lai K, et al. Endometriosis involving the mucosa of the intestinal
tract: A clinicopathologic study of 15 cases. Modern Pathology 2013;26:1270-8. DOI:
10.1038/modpathol.2013.51
Fig. 1. Microscopic image. A. The intestinal mucosa is shown. The muscular layer includes
tissue clusters comprised of linear glands, some tortuous and some overtly dilated. Some
hemosiderophages are seen (old bleeding). Since the glands are imbedded in a loose
stroma, this is identified as endometrial tissue. B. Endometrial cell cluster within the
muscular layer. Glands (straight, tortuous, dilated) are imbedded in a loosely cellular
stroma.
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