Endometriosis: a rare cause of small bowel obstruction

Abstract

Although endometriosis is a common condition in young women, symptomatic involvement of the small bowel is rare. The authors report the case of a 44-year-old lady initially thought to have irritable bowel syndrome who presented 1 month later with acute small bowel obstruction. A CT scan showed small bowel dilatation with a transition point in the ileum, but no distinct lesion. The patient had an exploratory laparotomy where an obstructing lesion in the terminal ileum and several enlarged mesenteric lymph nodes were identified. Consequently, a right hemicolectomy was performed. Pathology specimens showed multiple endometriotic foci in the bowel with stricturing of terminal ileum and appendiceal intussusception. This likely resulted in subocclusive episodes and intestinal obstruction. This case highlights the difficulty in establishing a preoperative diagnosis of endometriosis. Small bowel endometriosis should, therefore, be considered in the differential diagnosis of women of childbearing age who present with symptoms of obstruction.

Figure 1

Erect abdominal radiograph showing multiple dilated loops of small bowel and the absence of gas in the colon.

Figure 2

Abdominal CT scan image showing multiple fluid filled dilated loops of small bowel consistent with complete small bowel obstruction.

Figure 3

MRI with contrast shows area of focal eccentric mural thickening, demonstrates only mild contrast enhancement.