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Mabrouk M, Borghese G, Esposti ED, Raimondo D, Remorgida V, Arena A, Zupi E, Mattioli G, Ambrosio M, Seracchioli R. Acute abdominal pain in non-pregnant endometriotic patients: not just dysmenorrhoea. A systematic review. J OBSTET GYNAECOL 2020; 41:7-20. [PMID: 32312121 DOI: 10.1080/01443615.2019.1700946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Endometriosis, defined as the presence of functional endometrial tissue outside the uterine cavity, presents mainly with pelvic pain and infertility. Acute abdominal pain in non-pregnant patients with endometriosis might be minimised as a typical feature of the disease, while endometriosis is rarely considered in the differential diagnosis of acute abdominal pain. Our objective was to conduct a systematic review of the current literature of cases of acute abdomen/acute abdominal pain in non-pregnant endometriotic patients. We performed a PubMed/MEDLINE search of studies published from January 1990 to December 2018, selecting English language reports and series of non-pregnant patients with acute abdomen and histological confirmation of endometriosis. The studies were revised by two independent authors. Data were abstracted and compiled for analysis. Fifty articles reporting 62 patients were identified. The complications were classified according to anatomical sites in bowel, urinary tract, and genital organs emergencies. Rarely was the first diagnostic hypothesis endometriosis, misdiagnosis was frequent. The time frame from symptoms onset to management was often long. This is the first systematic review evaluating acute abdomen/acute abdominal pain in non-pregnant endometriotic patients. These conditions are rare but possibly life-threating and require prompt diagnosis and emergent medical or surgical treatment.
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Affiliation(s)
- Mohamed Mabrouk
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy.,Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.,Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Cambridge Clinical School, Cambridge, UK
| | - Giulia Borghese
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Eugenia Degli Esposti
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Diego Raimondo
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Valentino Remorgida
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Academic Unit of Obstetrics and Gynaecology, University of Genova, Genova, Italy
| | - Alessandro Arena
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Errico Zupi
- Obstetrics and Gynaecology Clinic, Department of Biomedicine and Prevention, University of Roma "Tor Vergata", Roma, Italy
| | - Giulia Mattioli
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Marco Ambrosio
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Renato Seracchioli
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy
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Hosseini S, Asemi R, Yassaee F, Moghaddam PB. Spontaneous ileocecal perforation induced by deep endometriosis. JBRA Assist Reprod 2019; 23:175-177. [PMID: 30633473 PMCID: PMC6501756 DOI: 10.5935/1518-0557.20180087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Bowel endometriosis is a rare condition that may cause catastrophic complications
necessitating immediate medical attention. This report describes the case of a
patient diagnosed with endometriosis-induced bowel perforation. Albeit rare,
bowel perforations caused by endometriosis should be considered in the
differential diagnosis of women of reproductive age with abdominal pain.
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Affiliation(s)
- Sedighe Hosseini
- Preventative Gynecology Research Center (PGRC), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Asemi
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fakhrolmolouk Yassaee
- Preventative Gynecology Research Center (PGRC), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parya Bamany Moghaddam
- Preventative Gynecology Research Center (PGRC), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Albareda J, Albi MV, Sosa G, Cano A, Macello ME, Albi Martin B. Puerperal ileal perforation secondary to endometriosis: Case report and literature review. Taiwan J Obstet Gynecol 2017; 55:121-4. [PMID: 26927263 DOI: 10.1016/j.tjog.2014.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2014] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Bowel endometriosis is an uncommon disease that can cause serious complications and may require immediate medical attention. We wish to remind about bowel perforation caused by endometriosis, its diagnostic difficulty, and the need or urgent management in late pregnancy and puerperium. CASE REPORT We present a 38-year-old woman, which presented with bowel perforation requiring urgent surgery. A pathological exam disclosed deep ileal infiltrative endometriosis. CONCLUSION Even though bowel endometriosis is a rare complication, it should be considered in the differential diagnosis of severe abdominal pain in late pregnancy or puerperium. A multidisciplinary management of these patients is needed.
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Affiliation(s)
- Judit Albareda
- Department of Obstetrics and Gynaecology, Hospital Universitario Fundación Alcorcón, Madrid, Spain.
| | - Manuel Victor Albi
- Department of Obstetrics and Gynaecology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Grevelyn Sosa
- Department of Pathology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Ana Cano
- Department of Obstetrics and Gynaecology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | | - Beatriz Albi Martin
- Department of Obstetrics and Gynaecology, Hospital Universitario Severo Ochoa, Madrid, Spain
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Mariani LL, Modaffari P, Mineccia M, Biglia N. Sonographic Pitfall in Endometriotic Ovarian Cysts: A Rare Case of a Spontaneous Sigmoid Colonic Perforation in a Nonpregnant Woman. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:2522-2523. [PMID: 27794133 DOI: 10.7863/ultra.16.01096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Luca Liban Mariani
- Academic Department of Gynecologic Oncology, Mauritian Hospital Umberto I, Torino, Italy
| | - Paola Modaffari
- Academic Department of Gynecologic Oncology, Mauritian Hospital Umberto I, Torino, Italy
| | - Michela Mineccia
- Department of General Surgery, Mauritian Hospital Umberto I, Torino, Italy
| | - Nicoletta Biglia
- Academic Department of Gynecologic Oncology, Mauritian Hospital Umberto I, Torino, Italy
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6
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Torralba-Morón A, Urbanowicz M, Ibarrola-De Andres C, Lopez-Alonso G, Colina-Ruizdelgado F, Guerra-Vales JM. Acute Small Bowel Obstruction and Small Bowel Perforation as a Clinical Debut of Intestinal Endometriosis: A Report of Four Cases and Review of the Literature. Intern Med 2016; 55:2595-9. [PMID: 27629952 DOI: 10.2169/internalmedicine.55.6461] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Endometriosis is a quite common pathology, however, intestinal endometriosis is a rare condition, which typically occurs with chronic symptoms. Its acute presentation is very infrequent. We herein report four cases of intestinal endometriosis, in which the clinical debut occurred acutely: two as an acute small bowel obstruction and two as a small bowel perforation. None of the cases had a preoperative diagnosis of endometriosis. The interest of these cases lies in this exceptional form of presentation, such as a surgical acute abdomen. Therefore, intestinal endometriosis should be taken into account in the differential diagnosis of an acute obstructive or perforative process of the small or large bowel.
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Ulrich U, Buchweitz O, Greb R, Keckstein J, von Leffern I, Oppelt P, Renner SP, Sillem M, Stummvoll W, De Wilde RL, Schweppe KW. National German Guideline (S2k): Guideline for the Diagnosis and Treatment of Endometriosis: Long Version - AWMF Registry No. 015-045. Geburtshilfe Frauenheilkd 2014; 74:1104-1118. [PMID: 26157194 PMCID: PMC4470398 DOI: 10.1055/s-0034-1383187] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
In this guideline, recommendations and standards for optimum diagnosis and treatment of endometriosis are presented. They are based on the analysis of the available scientific evidence as published in prospective randomized and retrospective studies as well as in systematic reviews. The guideline working group consisted of experts from Austria, Germany, Switzerland, and the Czech Republic.
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Affiliation(s)
- U. Ulrich
- Department of Obstetrics and Gynecology, Martin Luther Hospital,
Berlin
| | - O. Buchweitz
- Gynecological Outpatient Surgery Altonaer Straße, Hamburg
| | - R. Greb
- Center for Reproductive Medicine, Dortmund
| | - J. Keckstein
- Department of Obstetrics and Gynecology, Provincial Hospital,
Villach
| | - I. von Leffern
- Department of Obstetrics and Gynecology, Albertinen Hospital,
Hamburg
| | - P. Oppelt
- Department of Obstetrics and Gynecology, Provincial Womenʼs and
Childrenʼs Hospital, Linz
| | - S. P. Renner
- Department of Obstetrics and Gynecology, University of Erlangen School
of Medicine
| | - M. Sillem
- Gynecological Practice and Clinic Rosengarten, Mannheim
| | - W. Stummvoll
- Departement of Gynecology, Hospital of the Sisters of Mercy,
Linz
| | - R.-L. De Wilde
- Department of Obstetrics, Gynecology, and Gynecologic Oncology, Pius
Hospital Oldenburg, University of Oldenburg School of Medicine
| | - K.-W. Schweppe
- Endometriosis Center Ammerland, Ammerland Clinic,
Westerstede
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8
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Juhasz-Böss I, Laschke MW, Müller F, Rosenbaum P, Baum S, Solomayer EF, Ulrich U. Endometriosis: Survey of Current Diagnostic and Therapeutic Options and Latest Research Work. Geburtshilfe Frauenheilkd 2014; 74:733-742. [PMID: 25221341 DOI: 10.1055/s-0034-1382884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 06/29/2014] [Accepted: 06/30/2014] [Indexed: 01/21/2023] Open
Abstract
Endometriosis is one of the most frequent benign diseases in women of child-bearing age. The main symptoms are chronic upper abdominal pain and infertility. However, the aetiology and pathogenesis of endometriosis are as yet insufficiently clarified. Thus, therapy is mainly symptomatic with laparoscopic surgery being the gold standard. The aim of drug therapy is to achieve a hypo-oestrogenic condition. In cases of severe endometriosis and a desire to have children there is often an indication for assisted reproduction. The present article illustrates almost all current aspects on the diagnosis of and therapy of endometriosis. From the clinical viewpoint, emphasis is placed on the rare cases of deeply infiltrating endometriosis that are, however, accompanied with a high morbidity. Current therapeutic options in cases of infertility are also presented in more detail. Furthermore, special attention is paid to the latest research results from both clinical and basic research fields in order to demonstrate our current knowledge on the pathogenesis and, where possible, potentially related therapeutic options.
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Affiliation(s)
- I Juhasz-Böss
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - M W Laschke
- Institut für Klinisch-Experimentelle Chirurgie, Universität des Saarlandes, Homburg
| | - F Müller
- Klinik für Gynäkologie und Geburtshilfe, Martin-Luther-Krankenhaus, Berlin
| | - P Rosenbaum
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - S Baum
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - E F Solomayer
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - U Ulrich
- Klinik für Gynäkologie und Geburtshilfe, Martin-Luther-Krankenhaus, Berlin
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9
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Ulrich U, Buchweitz O, Greb R, Keckstein J, von Leffern I, Oppelt P, Renner SP, Sillem M, Stummvoll W, Schweppe KW. Interdisciplinary S2k Guidelines for the Diagnosis and Treatment of Endometriosis: Short Version - AWMF Registry No. 015-045, August 2013. Geburtshilfe Frauenheilkd 2013; 73:890-898. [PMID: 24771938 PMCID: PMC3975317 DOI: 10.1055/s-0033-1350810] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- U Ulrich
- Klinik für Gynäkologie und Geburtshilfe, Martin-Luther-Krankenhaus, Berlin
| | | | - R Greb
- Kinderwunschzentrum Dortmund, Dortmund
| | - J Keckstein
- Abteilung für Gynäkologie und Geburtshilfe, Landeskrankenhaus, Villach
| | - I von Leffern
- Klinik für Gynäkologie und Geburtshilfe, Albertinen-Krankenhaus, Hamburg
| | - P Oppelt
- Abteilung für Gynäkologie und Geburtshilfe, Landesfrauen- und Kinderklinik, Linz
| | - S P Renner
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - M Sillem
- Praxisklinik am Rosengarten, Mannheim
| | - W Stummvoll
- vormals Abteilung für Gynäkologie, Krankenhaus der Barmherzigen Schwestern, Linz
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10
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Kurogochi T, Fujita T, Iida N, Etoh K, Ogawa M, Yanaga K. Chronic abdominal pain, appendiceal mucinous neoplasm, and concurrent intestinal endometriosis: a case report. J Med Case Rep 2012; 6:327. [PMID: 23013935 PMCID: PMC3492044 DOI: 10.1186/1752-1947-6-327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 08/18/2012] [Indexed: 01/07/2023] Open
Abstract
Introduction Although both appendiceal tumor and intestinal endometriosis have been reported as rare causes of abdominal pain, the coexistence of appendiceal mucinous neoplasm and ileal endometriosis has not previously been reported. Case presentation A 41-year-old Japanese woman presented with a positive fecal occult blood test and a 3-year history of menstruation-related lower abdominal pain. A colonoscopy demonstrated extrinsic compression of the cecum, suggesting a mass arising from the appendix or adjacent structures. Abdominal imaging showed a 6-cm cystic mass with intraluminal thick fluids originating from the appendix. At ileocecal resection for an appendiceal tumor, a 2-cm mass in the terminal ileum was incidentally found, which was included in the surgical specimen. Microscopic examination confirmed a diagnosis of a mucinous neoplasm of the appendix with endometriosis of the terminal ileum. Conclusions To avoid urgent surgery for subsequent serious events associated with disease progression, appendiceal tumor and intestinal endometriosis should be ruled out in patients with chronic abdominal pain.
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Affiliation(s)
- Takanori Kurogochi
- Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, Japan.
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Pisanu A, Deplano D, Angioni S, Ambu R, Uccheddu A. Rectal perforation from endometriosis in pregnancy: Case report and literature review. World J Gastroenterol 2010; 16:648-51. [PMID: 20128037 PMCID: PMC2816281 DOI: 10.3748/wjg.v16.i5.648] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This case report describes a woman with spontaneous rectal perforation from decidualized endometriosis in pregnancy. A 37-year-old woman was admitted to our hospital at 30 wk of pregnancy with symptoms suggestive of pyelonephritis, which persisted until 33 wk of gestation when delivery of a premature male baby was performed through a cesarean section. On postoperative day 2, an abdominal computed tomography showed free air in the peritoneal cavity and a pelvic abscess. Explorative celiotomy revealed a diffuse severe fecaloid peritonitis that originated from a 3-cm wide rectal perforation. A Hartmann operation was then performed. Histopathological findings were consistent with decidualization of the rectal wall. Only 20 cases of intestinal perforation due to endometriosis have been reported in the literature. This report is believed to be the first case of spontaneous rectal perforation from endometriosis in pregnancy, and it shows the potential occurrence of serious and unexpected complications of the disease.
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Azordegan N, Yazdankhah A, Moghadasian MH. A rare case of coexistence of carcinoid tumor of appendix vermicularis and ileal endometriosis. Arch Gynecol Obstet 2008; 279:183-7. [PMID: 18470525 DOI: 10.1007/s00404-008-0660-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Accepted: 04/15/2008] [Indexed: 01/07/2023]
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Saito S, Murakami T, Suzuki K, Terada Y, Fukushima K, Moriya T. Intestinal endometriosis complicated by ileal perforation after initiation of gonadotropin-releasing hormone agonist therapy. Fertil Steril 2007; 88:969.e7-9. [PMID: 17493620 DOI: 10.1016/j.fertnstert.2006.12.082] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2006] [Revised: 12/28/2006] [Accepted: 12/28/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To report a rare complication of GnRH agonist therapy for intestinal endometriosis. DESIGN Case report. SETTING University hospital. PATIENT(S) A 45-year-old nulliparous Japanese woman with catamenial digestive symptoms. INTERVENTION(S) GnRH agonist therapy. MAIN OUTCOME MEASURE(S) Acute abdomenal crisis with free air in the abdominal X-ray. RESULT(S) An emergency laparotomy showed both an ileal constriction and perforation. An ileocecal enterectomy with an end-to-end anastomosis was performed. A pathological examination of the ileum revealed ileal endometriosis. CONCLUSION(S) Flare-up of intestinal endometriosis induced by GnRH agonist has the potential to lead to intestinal perforation. Careful diagnosis and treatment are necessary for cyclic and periodic gastrointestinal manifestation.
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Affiliation(s)
- Sayaka Saito
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
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López PA, Martín L, Vicente M, Girón O, del Pozo M. [Ileal endometriosis and Crohn's disease. A difficult differential diagnosis]. Cir Esp 2007; 82:122-4. [PMID: 17785147 DOI: 10.1016/s0009-739x(07)71679-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Endometriosis is an endometrial tissue proliferation that occurs in any extrauterine site and is usually confined to the pelvis. When the terminal ileum is affected, this entity can simulate Crohn's disease both clinically and radiologically. We describe 2 patients previously diagnosed with Crohn's disease with inadequate response to treatment, who showed intestinal obstruction located in the ileum. One patient had an enterocutaneous fistula, which is extremely unusual. In both patients intestinal endometriosis was diagnosed after histopathologic assessment. Although complex, the differential diagnosis between endometriosis and Crohn's disease should be kept in mind since the prognosis and treatment of these 2 entities differ.
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Affiliation(s)
- Pedro A López
- Servicio de Cirugía General y Aparato Digestivo II, Hospital Universitario Virgen de la Arrixaca, El Palmar, B.30007 Murcia, Spain.
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16
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Vanrell Garau M, Ginard Vicens D, Mariño Méndez Z, Bosque López MJ, Reyes Moreno J, Escarda Gelabert A, Corteza A, Gayá Cantallops J. [Ileal perforation secondary to intestinal endometriosis]. GASTROENTEROLOGIA Y HEPATOLOGIA 2007; 30:274-6. [PMID: 17493437 DOI: 10.1157/13101977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Endometriosis is defined as the presence of endometrial tissue outside the uterus. The bowel is not often affected. There are no specific clinical findings for intestinal endometriosis. It is typically asymptomatic, but sometimes can present with abdominal pain, diarrhoea, constipation or intestinal obstruction. Ileal perforation is a rare complication of intestinal endometriosis and only a few cases have been reported in the literature. Intestinal endometriosis can mimic many gastrointestinal diseases, such as irritable bowel syndrome, inflammatory bowel disease, infections and neoplasms. The diagnosis is made by laparoscopy or laparotomy. We present a case of a woman with intermittent abdominal pain and ileal perforation secondary to intestinal endometriosis.
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Affiliation(s)
- Margalida Vanrell Garau
- Servicio de Aparato Digestivo, Hospital Universitario Son Dureta, Andrea Doria 55, 07014 Palma de Mallorca, Mallorca, Spain
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Abstract
A 38-year-old woman with history of prior adrenalectomy for Cushing's syndrome presented with intermittent right lower quadrant (RLQ) abdominal pain, nausea, bloating, and non-bloody diarrhea for 2 months. Symptoms were not related to her menstrual periods. Examination revealed only an ill-defined mass in the RLQ. Investigations for infectious causes, inflammatory bowel disease, and carcinoid tumor were negative. Computed tomography (CT) demonstrated a terminal ileal mass with mesenteric stranding and dilatation of the proximal bowel. At laparotomy, a fibrotic, terminal ileal mass with matted adhesions involving the mesentery and retroperitoneum was resected. Histopathological examination identified multiple foci of endometriosis extending from the serosal surface into the mucosa of the terminal ileum. Immunostaining revealed E- and P-cadherin, but not N-cadherin immuno-positivity. Mucosal involvement without cyclical menstrual symptoms and intestinal obstruction is an unusual presentation of intestinal endometriosis. Although the mechanism of endometriosis is not clear, the role of cell adhesion molecules such as cadherins has received attention. Increased expression of E- and P-cadherin and decreased N-cadherin expression in our patient demonstrates differential expression of these cadherins in endometriotic tissue. Future studies may investigate patterns of differential expression of these cadherins in a series of cases to elucidate the mechanisms of migration of endometriotic tissue.
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Affiliation(s)
- Rahul Pannala
- Bridgeport Hospital/Yale University, Bridgeport, CT 06520, USA
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18
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Panel P, Chis C, Gaudin S, Letohic A, Raynal P, Mikhayelyan M, Fraleu B, Sangana G, Almeras C, Dufour C, Boidart F. Traitement cœlioscopique de l'endométriose profonde. À propos de 118 cas. ACTA ACUST UNITED AC 2006; 34:583-92. [PMID: 16822695 DOI: 10.1016/j.gyobfe.2006.06.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2005] [Accepted: 06/06/2006] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate risks and benefits of laparoscopic surgery of deep endometriosis, especially with bowel involvement with the aim of improve the inform consent of patients and choice of adequate management. PATIENTS AND METHODS Observational continuous study on 118 patients suffering from deep endometriosis (48 with bowel endometriosis) treated by laparoscopic surgery. RESULTS 95.6% of the patients improved their symptoms (93.7% for dyspareunia). Upon the 29 infertile patients, 21 (72%) got pregnant, including 14 (66%) spontaneously. During operative time, 3 laparotomies occurred, two of them for haemorrhage. During postoperative time, 4 major complications (2 rectal fistulas and 2 ureteral necrosis) and minor complications occurred. DISCUSSION AND CONCLUSIONS Those data confirm the efficiency of laparoscopic treatment of deep endometriosis especially for pain relief and fertility. Nevertheless, few but severe complications may occur. Therefore, it is imperative to deliver clear, loyal and appropriate information before to proceed to such a treatment.
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Affiliation(s)
- P Panel
- Service de gynécologie-obstétrique, hôpital André-Mignot, centre hospitalier de Versailles, 177, rue de Versailles, 78157 Le Chesnay cedex, France.
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Endometriosis intestinal como causa de rectorragia y masa intestinal. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2006. [DOI: 10.1016/s0210-573x(06)74098-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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20
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Roger N, Munoz-Bongrand N, Vila A, Allez M, Gornet JM, Cattan P, Lemann M, Sarfati E. [Exclusive ileal endometriosis]. ACTA ACUST UNITED AC 2006; 29:1157-9. [PMID: 16505762 DOI: 10.1016/s0399-8320(05)82181-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Endometriosis is a common condition, but its exclusive localization on the ileum is very rare. Unless there is catamenial exacerbation of symptoms, and considering the lack of specificity of results, diagnosis can be difficult. We report the case of a 50 year-old woman presenting with chronic pain in the right lower quadrant. Initial explorations revealed an ileal tumor which was not characterized before the occurrence of acute small bowel obstruction. Ileo-caecal resection by laparotomy relieved the symptoms and alllesions were removed. Diagnosis of ileal endometriosis was made by pathological examination of the resected specimen.
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Affiliation(s)
- Natacha Roger
- Services de Chirurgie Générale, Digestive et Endocrinienne, Hôpital Saint-Louis, AP-HP, Paris
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Cavaliere D, Schirru A, Parodi A, Caristo I, Panaro F, Jarzembowski TM, Cavaliere P. Successful laparoscopic treatment of ileocecal-appendicular endometriosis. J Laparoendosc Adv Surg Tech A 2005; 14:395-8. [PMID: 15684789 DOI: 10.1089/lap.2004.14.395] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Intestinal endometriosis is an uncommon clinical entity that is rarely seen by general surgeons. It traditionally requires laparoscopy for diagnosis and an open laparotomy procedure for the treatment. Herein, we report a rare case of colonic endometriosis involving the ileocecal region and left adnexal region. The management was totally laparoscopic: an ileocecal resection of the lesions was successfully performed. Endometriosis was not suspected preoperatively; however, it became a differential diagnosis during the operation and then confirmed by the histopathologic examination. We discuss the investigation process, surgical management, and prognosis related to ectopic endometriosis.
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Affiliation(s)
- Davide Cavaliere
- Department of Surgery, Division of General Surgery, San Paolo Hospital, Savona, Italy.
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