Journal of Reproduction & Infertility

Journal of Reproduction & Infertility

An Unusual Presentation of Endometriosis as an Ileocolic Intussusception with Cecal Mass: A Case Report

Authors
1 Gastrointestinal Ward, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
2 Department of Surgery, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
3 Department of Pathology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
Abstract
Background: Bowel endometriosis affects about 3.8-37% of women with endometriosis diagnosis. Most of the time endometriosis involves the recto-sigmoid .Right colon involvement is not common in endometriosis and also a few studies have reported obstructive endometriosis of bowel. Here, a case of endometriosis was reported with the ileocolic intussusception and cecal mass. Case Presentation: A 32y old woman was referred to Yas hospital due to severe low abdominal pain and vomiting. Ultrasonographic examination of her pelvis revealed bilateral ovarian cysts. Abdominal erect X-ray showed dilatation of small bowel segments. Diagnostic colonoscopy showed one small ulcer with the pressure effect of mass like lesion at cecum. The patient was taken to the operating room for excision of the mass; as a result the ileocolic intussusception was seen. After reduction, a firm mass was recognized at cecum so the ileocecal resection was performed. In pathologic examination of mass, endometriosis was reported. The postoperative period was uneventful. Conclusion: The diagnosis of bowel endometriosis is sometimes difficult. The case of bowel obstructive endometriosis is rare. Surgical excision of bowel endometriosis is necessary for symptomatic patients with bowel obstruction. Bowel endometriotic nodules are excised by nodulectomy or segmental resection.
Keywords

  1. Kim KJ, Jung SS, Yang SK, Yoon SM, Yang DH, Ye BD, et al. Colonoscopic findings and histologic diagnostic yield of colorectal endometriosis. J Clin Gastroenterol. 2011;45(6):536-41.
  2. Eljuga D, Klarić P, Grbavac I, Kuna K. Abdominal wall endometriosis: case report. Acta Clin Croat. 2012;51(2):261-3.
  3. Paramythiotis D, Stavrou G, Panidis S, Panagiotou D, Chatzopoulos K, Papadopoulos VN, et al. Concurrent appendiceal and umbilical endometriosis: a case report and review of the literature. J Med Case Rep. 2014;8:258.
  4. Ferrero S, Camerini G, Maggiore UL, Venturini PL, Biscaldi E, Remorgida V. Bowel endometriosis: recent insights and unsolved problems. World J Gastrointest Surg. 2011;3(3):31-8.
  5. Ono H, Honda S, Danjo Y, Nakamura K, Okabe M, Kimura T, et al. Rectal obstruction due to endometriosis: A case report and review of the Japanese literature. Int J Surg Case Rep. 2014;5(11):845-8.
  6. Soumekh A, Nagler J. Gastrointestinal endometriosis causing subacute intestinal obstruction with gradual development of weight loss and misdiagnosed as irritable bowel syndrome. Case Rep Gastroenterol. 2014;8(1):51-5.
  7. Ling CM, Lefebvre G. Extrapelvic endometriosis: a case report and review of the literature. J Soc Obstet Gynaecol Can. 2000;22(2):97-100.
  8. Seaman H, Ballard K, Wright J, de Vries C. Endometriosis and its coexistence with irritable bowel syndrome and pelvic inflammatory disease: findings from a national case control study Part 2. BJOG. 2008;115(11):1392-6.
  9. Hsu AL, Khachikyan I, Stratton P. Invasive and non-invasive methods for the diagnosis of endometriosis. Clin Obstet Gynecol. 2010;53(2):413-9.
  10. Milone M, Mollo A, Musella M, Maietta P, Sosa Fernandez LM, Shatalova O, et al. Role of colonoscopy in the diagnostic work-up of bowel endometriosis. World J Gastroenterol. 2015;21(16):4997-5001.
  11. Redwine DB. Ovarian endometriosis: a marker for more extensive pelvic and intestinal disease. Fertil Steril. 2015;72(2):310-5.
  12. Remorgida V, Ferrero S, Fulcheri E, Ragni N, Martin DC. Bowel endometriosis: presentation, diagnosis, and treatment. Obstet Gynecol Surv. 2007;62(7):461-70.