Laparoscopic treatment of colonic endometriosis causing periodic abdominal pain and hematochezia: A case report

RATIONALE

Endometriosis, a benign disease, has a malignant biological behavior and is highly prone to recurrence. Although gastrointestinal involvement is the most common site for extra-genital endometriosis, deep infiltrative endometriosis, which affects the mucosal layer, is very rare.

PATIENT CONCERNS

A 44-year-old woman with a 6-month history of recurring abdominal pain and Hematochezia. The patient visited several hospitals over the past six months and was suspected to have been diagnosed with a digestive disease, for which medication was ineffective, leading to a great deal of anxiety.

DIAGNOSES

Colonic endometriosis.

INTERVENTIONS

After a thorough imaging evaluation and preoperative discussion, laparoscopic colonic endometriosis resection under indocyanine green indication was performed by gynecologists and gastroenterologists.

OUTCOMES

After laparoscopic treatment, the patient's symptoms improved significantly, with occasional pain felt and no blood in the stool.

LESSONS

This case provides a rare example of sigmoid endometriosis causing periodic abdominal pain and Hematochezia. We report a clinical case to investigate the feasibility of an indocyanine green fluorescent contrast technique to guide the scope of surgery in laparoscopic deep infiltrative endometriosis surgery. In intestinal endometriosis surgery, indocyanine green fluoroscopy may indicate the lesion's precise localization.

Deep Endometriosis of the Terminal Ileum Presenting With Cyclic Recurrent Small Bowel Obstruction

Here, we discuss a case of a 42-year-old premenopausal female who presented with chronic pelvic pain and recurrent small bowel obstruction during menstruation. The patient reported a nine-year history of pelvic pain and a four-year history of episodic small bowel obstruction requiring multiple prior inpatient admissions. During these admissions, the obstruction was managed conservatively with bowel rest and nasogastric tube placement; however, symptoms would recur with subsequent menstrual cycles. Computed tomography showed diffusely dilated loops of small bowel with a transition point in the central anterior pelvis, and magnetic resonance enterography revealed a mass-like area involving small bowel loops in the mid pelvis. The patient underwent laparoscopic surgical intervention including bowel resection with re-anastomosis, hysterectomy, bilateral salpingectomy, and left oophorectomy. Intraoperative findings included severe distention of the proximal bowel with a discrete deep endometriosis lesion of the terminal ileum which was confirmed on final pathologic examination. This case emphasizes the importance of considering endometriosis as the etiology of recurrent catamenial small bowel obstruction, particularly in premenopausal women.

A Rare Case of Complete Perforation of Endometrial Tissue Through the Mucosa of the Sigmoid Colon

Endometriosis is a disease that causes endometrial tissues to proliferate outside of the uterus. The condition is often attributed to estrogen imbalance and can lead to severe inflammation and bleeding, where it is believed that 10% of female patients experience this illness. Endometrial growth can occur in the ovaries, fallopian tubes, stomach, and gastrointestinal tract. Twelve percent of endometriosis cases can be seen in the intestines, with the rectosigmoid colon accounting for 72% of these cases. Patients with intestinal endometriosis may present with moderate symptoms, such as constipation, but they may experience more serious complications as well such as intestinal bleeding. Although the presence of endometrial tissue in the colon is already a rare phenomenon, it is even rarer for endometrial growth to perforate the entire mucosa of the sigmoid colon. A study in 2010 reported that only 21 of such cases have occurred since 1931. The patient in this case report had a gene (MUTYH) mutation that put her at risk for colorectal cancer, and she was ultimately treated with segmental resection of the sigmoid colon. The final pathology of the specimen revealed that the patient's lesion was endometrial growth. In this case report, we present a rare finding of endometrial tissue perforating through a patient's intestinal lumen, which was successfully treated with surgical intervention.

Rare Case of Ileocecal Obstruction Secondary to Endometriosis Presenting for the First Time

Though endometriosis involving the intestines is well known, it causing ileocecal obstruction is a rare presentation. Etiology for ileocecal obstruction may not be known in all the cases preoperatively and may sometimes need resection and histopathology for diagnosis. Here we present a case of endometriosis presenting for the first time as an ileocecal obstruction in a 39-year-old lady who presented to us with complaints of intermittent abdominal pain. Contrast CT scan of the abdomen showed terminal ileal stricture and wall thickening. She underwent diagnostic laparoscopy, which showed dilated distal small bowel loops with suspicious stricturing growth at the terminal ileum and ileocecal valve region. A formal laparoscopic right hemicolectomy was done and post-operative histopathology revealed endometriosis with fibrosis, causing a luminal obstruction. In conclusion, endometriosis should be considered as a rare differential in patients presenting with ileocecal obstruction and having inconclusive features on imaging, endoscopic or biopsy, especially in women of childbearing age.

Endometriosis of the Small Bowel: A Diagnostic Enigma

Endometriosis refers to the implantation and proliferation of endometrial tissue outside the uterus. Small bowel endometriosis is an uncommon location for endometrial deposits and when present, it can pose diagnostic difficulty. Here, we present a case of a 50-year-old female with small bowel endometriosis who suffered from recurrent attacks of colicky abdominal pain for few months. Her cross-sectional investigations remained largely inconclusive. Ultimately, she underwent diagnostic laparoscopy which was diagnostic and therapeutic.

Clinical practice guidelines for the treatment of extragenital endometriosis in Japan, 2018

The aim of this publication is to disseminate the clinical practice guidelines for the treatment of intestinal, bladder/ureteral, thoracic and umbilical endometriosis, already published in Japanese, to non-Japanese speakers. For developing the original Japanese guidelines, the clinical practice guideline committee was formed by the research team for extragenital endometriosis, which is part of the research program of intractable disease of the Japanese Ministry of Health, Labor and Welfare. The clinical practice guideline committee formulated eight clinical questions for the treatment of extragenital endometriosis, which were intestinal, bladder/ureteral, thoracic and umbilical endometriosis. The committee performed a systematic review of the literature to provide responses to clinical questions and developed clinical guidelines for extragenital endometriosis, according to the process proposed by the Medical Information Network Distribution Service. The recommendation level was determined using modified Delphi methods. The clinical practice guidelines were officially approved by the Japan Society of Obstetrics and Gynecology and the Japan Society of Endometriosis. This English version was translated from the Japanese version.

[Ileal endometriosis. An uncommon cause of bowel obstruction in women in fertile age]

Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity. It affects ~5-10% of women in their reproductive years. When it affects the intestine, it tends to be confused clinically with a wide variety of affections, which is why it has sometimes been called "the great simulator". A review of the literature shows that intestinal localization is rare and that obstruction secondary to this cause is even more unusual, with preoperative diagnosis being a challenge for surgeons. With the purpose of highlighting clinical and diagnostic imaging characteristics that help the preoperative suspicion of this entity, so rare in routine practice, we present two cases of women who underwent emergency surgery, without a previous diagnosis of endometriosis and with intestinal occlusion as the first manifestation of the disease. Treatment of intestinal occlusion by endometriosis consists of intestinal resection of the affected sector and primary anastomosis. Diagnosis of intestinal occlusion secondary to ileal endometriosis is based on a high index of suspicion and should be considered in women of childbearing age, without a history of disease and with a history of painful menstruation.

[Intestinal endometriosis - a case report]

Endometriosis intestines due to its non-specific symptoms can pose diagnostic problems, a lack of or incorrect treatment worsens the quality of life, sometimes leading to serious complications. The differential diagnosis of abdominal pain, especially in patients of reproductive age should be taken disease into account. Often abdominal pain in young women are classified as a functional gastrointestinal disorder, and only carefully collected intelligence allows you to focus on the diagnosis of endometriosis, especially if the symptoms significantly impair quality of life.

A CASE REPORT

A woman 32 year old who was admitted to the department of gastroenterology because of increasing pain in the abdomen. Due to the deteriorating condition of the patient, the characteristics of mechanical obstruction on imaging studies was transferred to the surgical ward with suspected Crohn's disease. She was treated surgically. Histopathological examination found endometriosis.

CONCLUSIONS

Endometriosis outside the sex system can lead to serious complications.

Puerperal ileal perforation secondary to endometriosis: Case report and literature review

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.