Acute small bowel obstruction secondary to intestinal endometriosis, an elusive condition: a case report

Abstract

Background: Endometriosis is a benign condition affecting females of reproductive age. Although intestinal endometriosis is common it is rare for the condition to manifest as an acute bowel obstruction secondary to ileocaecal and appendicular endometriosis. This case is important to report as it highlights the diagnostic difficulty this particular condition presents to an emergency surgeon.

Case presentation: We present the case of a 33 year old female of Asian origin who presented with symptoms and signs of an acute small bowel obstruction. A right hemicolectomy for suspected malignancy was performed with an ileocolic anastomosis. Histological examination demonstrated extensive endometriosis of the appendix and ileocaecal junction.

Conclusion: Enteric endometriosis should be considered as a differential diagnosis when assessing females of reproductive age with acute small bowel obstruction. A high index of suspicion is required to arrive at a diagnosis of this elusive condition.

Figure 1

macroscopic appearance of the resected specimen showing the caecal nodule.

Figure 2

microscopic appearance of endometriotic nodule in the submucosa comprising endometrial glands and surrounding stroma (magnification 20×).