Ileal endometriosis presenting as acute small intestinal obstruction: a case report

Abstract

Background: the gastrointestinal tract is the most common site of extrapelvic endometriosis, affecting 5%-15% of women with pelvic endometriosis. Among women with intestinal endometriosis, rectum and sigmoid colon are the most commonly involved areas. Terminal ileum is rarely involved in endometriosis. Similarly, bowel endometriosis is an uncommon cause of intestinal obstruction.

Objective: to present a rare occurrence of ileal endometriosis presenting with acute small intestinal obstruction.

Methods: a 34-year-old woman presented with a two-month history of intermittent, colicky abdominal pain which became more intense with associated vomiting of three days prior to presentation. Besides full clinical evaluation, she had other investigations including abdominal X-rays, ultrasonography, ECG, and echocardiography. The results of these informed the need for myomectomy.

Results: besides the abdominal pain, the patient also complained of a supra-pubic swelling and menorrhagia. Physical examination showed an incisional hernia, and a suprapubic mass. The results of evaluation were consistent with incisional hernia complicated by imminent adhesive intestinal obstruction. She had had secondary infertility and has had myomectomy due to copious menstrual flow which was complicated with incisional hernia. She was managed initially conservatively for adhesive small bowel obstruction which failed. She had exploratory laparotomy with small intestinal resection and end to end anastomosis. Histopathology of the resected mass revealed ileal endometriosis.

Conclusion: this report highlights the importance of histopathological assessment of resected specimens in the diagnosis of intestinal obstruction due to intestinal endometriosis. This disease should, therefore, be considered during the evaluation of women of child bearing age.