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: mavila_v@uas.edu.mx

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.