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Neme GL, Guimarães CTS, Dantas PP, Santana DDB, Yamauchi FI, Filho HML, Bittencourt LK, Pereira RMA, Mattos LA. Postoperative Imaging of Endometriosis. Radiographics 2024; 44:e230159. [PMID: 38512726 DOI: 10.1148/rg.230159] [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: 03/23/2024]
Abstract
Endometriosis is a highly prevalent disease that affects 10%-15% of women of reproductive age worldwide and is mainly associated with chronic pelvic pain and infertility. With the widespread use of imaging for the diagnosis and monitoring of endometriosis, combined with the ability of surgery to eradicate the disease and address infertility, there has been a significant increase in recent years in imaging examinations for postoperative evaluation of endometriosis. US and MRI are used not only to help diagnose and map endometriosis but also to evaluate refractory symptoms, residual lesions, and complications at posttreatment assessment. Knowledge of surgical techniques and recognition of expected postoperative imaging findings are crucial to differentiate postoperative changes from residual disease and/or recurrence. The authors discuss imaging aspects of postoperative endometriosis, with an emphasis on the imaging approach, comprehension of surgical techniques, recognition of the expected findings, possible complications, and analysis of residual disease or recurrence. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material. See the invited commentary by VanBuren in this issue. The slide presentation from the RSNA Annual Meeting is available for this article.
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Affiliation(s)
- Glaucy L Neme
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Cassia T S Guimarães
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Patricia P Dantas
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Daniel D B Santana
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Fernando I Yamauchi
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Hilton M Leão Filho
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Leonardo K Bittencourt
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Ricardo M A Pereira
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Leandro A Mattos
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
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2
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Chan M, Ono Y, Kotani J, Itou T, Kinoshita Y. Repetitive abdominal pain in a reproductive-aged woman. Clin Case Rep 2023; 11:e8108. [PMID: 37915732 PMCID: PMC10616908 DOI: 10.1002/ccr3.8108] [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] [Received: 09/10/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 11/03/2023] Open
Abstract
We report a young woman with ileocecal endometriosis who presented with repeated abdominal pain. Under hormonal effects, the endometrium may proliferate and cause bleeding in the bowel wall, leading to cyclical abdominal pain. When recurring abdominal pain is observed in reproductive-aged women, physicians should always be aware of gastrointestinal endometriosis.
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Affiliation(s)
- Minnie Chan
- Department of Internal MedicineSteel Memorial Hirohata HospitalHimejiHyogoJapan
- Department of Disaster and Emergency Medicine, Graduate School of MedicineKobe UniversityKobeHyogoJapan
| | - Yuko Ono
- Department of Disaster and Emergency Medicine, Graduate School of MedicineKobe UniversityKobeHyogoJapan
| | - Joji Kotani
- Department of Disaster and Emergency Medicine, Graduate School of MedicineKobe UniversityKobeHyogoJapan
| | - Takashi Itou
- Department of PathologySteel Memorial Hirohata HospitalHimejiHyogoJapan
| | - Yoshikazu Kinoshita
- Department of Internal MedicineSteel Memorial Hirohata HospitalHimejiHyogoJapan
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Mușat F, Păduraru DN, Bolocan A, Constantinescu A, Ion D, Andronic O. Endometriosis as an Uncommon Cause of Intestinal Obstruction-A Comprehensive Literature Review. J Clin Med 2023; 12:6376. [PMID: 37835020 PMCID: PMC10573381 DOI: 10.3390/jcm12196376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/20/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
The prevalence of intestinal endometriosis has been estimated to be between 3% and 37% of all endometriosis cases. Cases of intestinal occlusion due to endometriosis foci on the small bowel and on the large bowel are even rarer, with a reported prevalence of 0.1-0.7%. The aim of this literature review was to summarize the available published evidence on the diagnosis, characteristics, and management of intestinal occlusion due to endometriosis. The search on PubMed retrieved 295 records, of which 158 were rejected following a review of the title and abstract. After reviewing the full text, 97 studies met the Population, Intervention, Comparator, Outcomes, and Study (PICOS) criteria and were included in the analysis. The total number of patients with bowel occlusion due to endometriosis included in the studies was 107. The occlusive endometrial foci were localized on the ileum in 38.3% of the cases, on the rectosigmoid in 34.5% of the cases, at the ileocecal junction and the appendix in 14.9% of the cases, and at the rectum in 10.2% of the cases. Only one case reported large bowel obstruction by endometriosis of the hepatic flexure of the colon extending to the transverse colon (0.9%), and in one case the obstruction was caused by an omental giant endometrioid cyst compressing the intestines. We identified six cases of postmenopausal females with acute bowel obstruction due to endometriosis. Malignant degeneration of endometriosis was also identified as a cause of intestinal occlusion. The mechanisms of obstruction include the presence of a mass in the lumen of the intestine or in the wall of the intestine, extrinsic compression, adhesions, or intussusception.
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Affiliation(s)
- Florentina Mușat
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, The University Emergency Hospital of Bucharest, 050098 Bucharest, Romania; (F.M.); (A.B.); (D.I.); (O.A.)
| | - Dan Nicolae Păduraru
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, The University Emergency Hospital of Bucharest, 050098 Bucharest, Romania; (F.M.); (A.B.); (D.I.); (O.A.)
| | - Alexandra Bolocan
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, The University Emergency Hospital of Bucharest, 050098 Bucharest, Romania; (F.M.); (A.B.); (D.I.); (O.A.)
| | - Alexandru Constantinescu
- Gastroenterology Department, Carol Davila University of Medicine and Pharmacy, The University Emergency Hospital of Bucharest, 050098 Bucharest, Romania;
| | - Daniel Ion
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, The University Emergency Hospital of Bucharest, 050098 Bucharest, Romania; (F.M.); (A.B.); (D.I.); (O.A.)
| | - Octavian Andronic
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, The University Emergency Hospital of Bucharest, 050098 Bucharest, Romania; (F.M.); (A.B.); (D.I.); (O.A.)
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Yeo D, Ladlad JG, Tan WJ. A Fortunate Twist. Gastroenterology 2023; 164:e7-e9. [PMID: 35964695 DOI: 10.1053/j.gastro.2022.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/09/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Delphina Yeo
- Colorectal Service, Department of General Surgery, Sengkang General Hospital, Singapore
| | - Jasmine G Ladlad
- Colorectal Service, Department of General Surgery, Sengkang General Hospital, Singapore
| | - Winson Jianhong Tan
- Colorectal Service, Department of General Surgery, Sengkang General Hospital, Singapore.
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Carvalho AC, Cardoso R, Pires F, Ventura S, Portela F, Ministro P, Silva A. Diagnosis of Bowel Endometriosis Using Endoscopic Ultrasound-guided Fine Needle Aspiration. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2023; 81:46-51. [PMID: 36695067 DOI: 10.4166/kjg.2022.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/02/2022] [Accepted: 09/20/2022] [Indexed: 01/26/2023]
Abstract
Endometriosis is a relatively common gynecological condition in women of reproductive age. The rectosigmoid region is the most commonly affected segment when the gastrointestinal tract is involved. A differential diagnosis of colorectal neoplasia is difficult because of the similar clinical, endoscopic, and radiology findings. A 42-year-old female presented with abdominal distention and was subsequently diagnosed with a large bowel obstruction in the rectum. A temporary colostomy was performed, and endoscopy revealed a rectal mass obstructing the rectum. The biopsy showed normal mucosa, and it was difficult to exclude rectal malignancies even after the imaging workup. Endoscopic ultrasound demonstrated a hypoechoic lesion below the rectal mucosa, and fine needle aspiration confirmed the diagnosis of bowel endometriosis. Bowel endometriosis is a challenging diagnosis. Endoscopic ultrasound- guided fine-needle aspiration is useful for acquiring adequate samples for histological confirmation and a definitive diagnosis of bowel endometriosis.
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Affiliation(s)
- Ana Catarina Carvalho
- Department of Gastroenterology, Centro Hospitalar Tondela-Viseu, E.P.E., Viseu, Portugal
| | - Ricardo Cardoso
- Department of Gastroenterology, Centro Hospitalar Tondela-Viseu, E.P.E., Viseu, Portugal
| | - Francisco Pires
- Department of Gastroenterology, Centro Hospitalar Tondela-Viseu, E.P.E., Viseu, Portugal
| | - Sofia Ventura
- Department of Gastroenterology, Centro Hospitalar Tondela-Viseu, E.P.E., Viseu, Portugal
| | - Francisco Portela
- Department of Gastroenterology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Paula Ministro
- Department of Gastroenterology, Centro Hospitalar Tondela-Viseu, E.P.E., Viseu, Portugal
| | - Américo Silva
- Department of Gastroenterology, Centro Hospitalar Tondela-Viseu, E.P.E., Viseu, Portugal
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Transvaginal Ultrasound in the Diagnosis and Assessment of Endometriosis-An Overview: How, Why, and When. Diagnostics (Basel) 2022; 12:diagnostics12122912. [PMID: 36552919 PMCID: PMC9777206 DOI: 10.3390/diagnostics12122912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/16/2022] [Accepted: 11/19/2022] [Indexed: 11/24/2022] Open
Abstract
Endometriosis is a common gynaecological disease, causing symptoms such as pelvic pain and infertility. Accurate diagnosis and assessment are often challenging. Transvaginal ultrasound (TVS), along with magnetic resonance imaging (MRI), are the most common imaging modalities. In this narrative review, we present the evidence behind the role of TVS in the diagnosis and assessment of endometriosis. We recognize three forms of endometriosis: Ovarian endometriomas (OMAs) can be adequately assessed by transvaginal ultrasound. Superficial peritoneal endometriosis (SUP) is challenging to diagnose by either imaging modality. TVS, in the hands of appropriately trained clinicians, appears to be non-inferior to MRI in the diagnosis and assessment of deep infiltrating endometriosis (DIE). The IDEA consensus standardized the terminology and offered a structured approach in the assessment of endometriosis by ultrasound. TVS can be used in the non-invasive staging of endometriosis using the available classification systems (rASRM, #ENZIAN). Given its satisfactory overall diagnostic accuracy, wide availability, and low cost, it should be considered as the first-line imaging modality in the diagnosis and assessment of endometriosis. Modifications to the original ultrasound technique can be employed on a case-by-case basis. Improved training and future advances in ultrasound technology are likely to further increase its diagnostic performance.
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Mabrouk M, Raimondo D, Cofano M, Cocchi L, Paradisi R, Seracchioli R. Diagnosis and treatment of uncommon ileal endometriosis: a case report and literature review. Facts Views Vis Obgyn 2021; 13:405-410. [PMID: 35026103 PMCID: PMC9148712 DOI: 10.52054/fvvo.13.4.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity. It is a common finding in premenopausal women and commonly affects the gastrointestinal tract, especially the rectosigmoid tract. Small bowel involvement is rare and usually asymptomatic making diagnosis difficult. Here we report an uncommon case of exophytic ileal endometriosis surgically treated. Detailed pre-operative counselling on the risk of ileal surgery should always be considered in all cases with endometriosis requiring surgery. We also present a review of the literature regarding the clinical presentation, diagnosis, and treatment of this challenging condition.
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8
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Peacock T, Harrison W, Limmer A, Di Sano S, Wong KS. Ileal endometriosis: a rare cause of multifocal small bowel strictures. ANZ J Surg 2021; 92:1914-1915. [PMID: 34842315 DOI: 10.1111/ans.17377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Timothy Peacock
- Department of General Surgery, The Tweed Hospital, Tweed Heads, New South Wales, Australia
| | - William Harrison
- Department of General Surgery, The Tweed Hospital, Tweed Heads, New South Wales, Australia
| | - Alexandra Limmer
- Department of General Surgery, The Tweed Hospital, Tweed Heads, New South Wales, Australia
| | - Suzanne Di Sano
- Department of General Surgery, The Tweed Hospital, Tweed Heads, New South Wales, Australia
| | - King-Sang Wong
- Department of General Surgery, The Tweed Hospital, Tweed Heads, New South Wales, Australia
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Verpillat P, Fourquet T, Kamus É, Collinet P, Jacques AS, Capelle C, Bugeaud M, Puech P, Rubod C. Images pièges et difficultés diagnostiques dans le cadre d’un bilan d’endométriose pelvienne : intérêt de la confrontation radioclinique. IMAGERIE DE LA FEMME 2021. [DOI: 10.1016/j.femme.2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Association Between Bowel Obstruction or Intussusception and Endometriosis. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 43:440-446. [PMID: 33359555 DOI: 10.1016/j.jogc.2020.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/30/2020] [Accepted: 12/02/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To evaluate the association between endometriosis and bowel obstruction or intussusception using a large population database. METHODS This was a population-based study using data from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) from 2005 to 2014. We studied women aged 18 to 55 years without inflammatory bowel disease or cancer. Multivariate logistic regression was used to examine the association between endometriosis and bowel obstruction. RESULTS Of the 18 427 520 women who met the criteria for inclusion, 96 539 had experienced bowel obstruction, for an overall prevalence of 52 per 10 000, and 3825 had experienced intussusception, for an overall prevalence of 2 per 10 000. When adjusted for sociodemographic characteristics, women with pelvic endometriosis had a consistently higher likelihood of bowel obstruction (odds ratio [OR] 2.6; 95% confidendence interval [CI] 2.3-3.00, P <0.01). In particular, intestinal endometriosis was associated with a 14.6-fold increased risk of bowel obstruction (95% CI 11.4-18.8, P <0.01), while rectovaginal endometriosis was associated with a 2.00-fold increased risk (95% CI 1.5-2.6, P <0.01). Pelvic endometriosis was significantly associated with adhesive bowel obstruction (adjusted OR: 3.2; 95% CI 2.6-3.9) and non-adhesive bowel obstruction (adjusted OR 2.4; 95% CI 2.0-2.8). The rates of endometriosis among women with or without intussusception were comparable. CONCLUSIONS Pelvic endometriosis, in particular rectovaginal and intestinal endometriosis is strongly associated with bowel obstruction, independent of the presence of intra-abdominal adhesions. We did not find any association between pelvic endometriosis and intussusception.
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Lam K, Lang E. Endometriosis as a rare cause of small bowel obstruction. ANZ J Surg 2020; 90:E137-E138. [PMID: 32339367 DOI: 10.1111/ans.15916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/08/2020] [Accepted: 04/10/2020] [Indexed: 01/07/2023]
Affiliation(s)
- Kenneth Lam
- Department of Surgery, Monash Health, Melbourne, Victoria, Australia
| | - Emma Lang
- Department of Surgery, Monash Health, Melbourne, Victoria, Australia
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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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Zhu MY, Fei FM, Chen J, Zhou ZC, Wu B, Shen YY. Endometriosis of the duplex appendix: A case report and review of the literature. World J Clin Cases 2019; 7:2094-2102. [PMID: 31423443 PMCID: PMC6695541 DOI: 10.12998/wjcc.v7.i15.2094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/18/2019] [Accepted: 06/26/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Duplication of the appendix is an infrequent congenital malformation with a complex classification. The horseshoe appendix is a subtype of the duplex appendix and is rarely reported in the literature. Endometriosis is a common gynecological disease that rarely occurs in the appendix. Moreover, horseshoe appendix combined with endometriosis has not been previously reported. CASE SUMMARY Here, we describe a 44-year-old woman who was admitted with a 1-d history of migratory lower right quadrant pain. Physical examination was consistent with the signs of acute appendicitis. The patient underwent an emergency exploratory laparotomy. The distal tip of the appendix was in contact with the cecum by another base, or "horseshoe appendix". In addition, a small intestinal mass and an ovarian mass were identified. Subsequently, appendectomy, partial resection of the small intestine, and right oophorectomy were successively performed. The histopathology confirmed the diagnosis of acute inflammation of the duplex appendix with endometriosis, small intestine endometriosis, and ovarian endometriosis. CONCLUSION Surgeons need to be aware of the possibility of the duplex appendix when performing an appendectomy, and this study emphasizes the importance of exploring the entire abdomen.
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Affiliation(s)
- Ming-Yuan Zhu
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Fa-Ming Fei
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Jing Chen
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Zhong-Cheng Zhou
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Bin Wu
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Yi-Yu Shen
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
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14
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Choi JDW, Yunaev M. Endometriosis of the appendix causing small bowel obstruction in a virgin abdomen. BMJ Case Rep 2019; 12:12/7/e230496. [PMID: 31337629 DOI: 10.1136/bcr-2019-230496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
A 29-year-old, otherwise well, nulligravid woman presented to the emergency department with 1-day history of generalised abdominal pain and vomiting. She had similar symptoms 6 months prior following recent menstruations, which resolved conservatively. She had no prior history of abdominal surgery or endometriosis. CT scan demonstrated distal small bowel obstruction. A congenital band adhesion was suspected, and she underwent prompt surgical intervention. During laparoscopy, a thickened appendix was adhered to a segment of distal ileum. There was blood in the pelvis. Laparoscopic adhesiolysis and appendicectomy were performed. Histopathology demonstrated multiple foci of endometriosis of the appendix with endometrial glands surrounded by endometrial stroma. Oestrogen receptor and CD10 immunostains highlighted the endometriotic foci. The patient made a good recovery and was referred to a gynaecologist for further management.
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Affiliation(s)
- Joseph Do Woong Choi
- Department of Surgery, Norwest Private Hospital, Sydney, New South Wales, Australia
| | - Michael Yunaev
- Department of Surgery, Norwest Private Hospital, Sydney, New South Wales, Australia
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15
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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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16
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Alio L, Angioni S, Arena S, Bartiromo L, Bergamini V, Berlanda N, Bonanni V, Bonin C, Buggio L, Candiani M, Centini G, D'Alterio MN, De Stefano F, Di Cello A, Exacoustos C, Fedele L, Frattaruolo MP, Geraci E, Lavarini E, Lazzeri L, Luisi S, Maiorana A, Makieva S, Maneschi F, Martire F, Massarotti C, Mattei A, Muzii L, Ottolina J, Pagliardini L, Perandini A, Perelli F, Pino I, Porpora MG, Remorgida V, Scagnelli G, Seracchioli R, Solima E, Somigliana E, Sorrenti G, Ticino A, Venturella R, Viganò P, Vignali M, Zullo F, Zupi E. Endometriosis: seeking optimal management in women approaching menopause. Climacteric 2019; 22:329-338. [PMID: 30628469 DOI: 10.1080/13697137.2018.1549213] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The incidence of endometriosis in middle-aged women is not minimal compared to that in the reproductive age group. The treatment of affected women after childbearing age to the natural transition toward menopause has received considerably poor attention. Disease management is problematic for these women due to increased contraindications regarding hormonal treatment and the possibility for malignant transformation, considering the increased cancer risk in patients with a long-standing history of the disease. This state-of-the-art review aims for the first time to assess the benefits of the available therapies to help guide treatment decisions for the care of endometriosis in women approaching menopause. Progestins are proven effective in reducing pain and should be preferred in these women. According to the international guidelines that lack precise recommendations, hysterectomy with bilateral salpingo-oophorectomy should be the definitive therapy in women who have completed their reproductive arc, if medical therapy has failed. Strict surveillance or surgery with removal of affected gonads should be considered in cases of long-standing or recurrent endometriomas, especially in the presence of modifications of ultrasonographic cyst patterns. Although rare, malignant transformation of various tissues in endometriosis patients has been described, and management is herein discussed.
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Affiliation(s)
- L Alio
- a Department of Obstetrics and Gynecology , Civico Hospital , Palermo , Italy
| | - S Angioni
- b Department of Surgical Sciences , University of Cagliari , Cagliari , Italy
| | - S Arena
- c Department of Obstetrics and Gynecology , Azienda Ospedaliera Perugia , Perugia , Italy
| | - L Bartiromo
- d Gynecology Department , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - V Bergamini
- e Department of Obstetrics and Gynecology , Azienda Ospedaliera Universitaria Integrata , Verona , Italy
| | - N Berlanda
- f Department of Clinical Sciences and Community Health , Università degli Studi di Milano , Milan , Italy.,g Gynaecology Unit , Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - V Bonanni
- h Department of Gynecology, Obstetrics and Urology , ' Sapienza' University of Rome , Rome , Italy
| | - C Bonin
- e Department of Obstetrics and Gynecology , Azienda Ospedaliera Universitaria Integrata , Verona , Italy
| | - L Buggio
- g Gynaecology Unit , Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - M Candiani
- d Gynecology Department , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - G Centini
- i Department of Molecular and Developmental Medicine, Obstetrics and Gynecology , University of Siena , Siena , Italy
| | - M N D'Alterio
- b Department of Surgical Sciences , University of Cagliari , Cagliari , Italy
| | - F De Stefano
- d Gynecology Department , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - A Di Cello
- j Department of Clinical and Experimental Medicine, Obstetrics and Gynecology , Università degli Studi Magna Graecia , Catanzaro , Italy
| | - C Exacoustos
- k Department of Biomedicine and Prevention , Università degli studi di Roma 'Tor Vergata' , Rome , Italy
| | - L Fedele
- f Department of Clinical Sciences and Community Health , Università degli Studi di Milano , Milan , Italy.,g Gynaecology Unit , Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - M P Frattaruolo
- g Gynaecology Unit , Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - E Geraci
- l Department of Obstetrics and Gynecology , Asola Hospital , Mantova , Italy
| | - E Lavarini
- e Department of Obstetrics and Gynecology , Azienda Ospedaliera Universitaria Integrata , Verona , Italy
| | - L Lazzeri
- i Department of Molecular and Developmental Medicine, Obstetrics and Gynecology , University of Siena , Siena , Italy
| | - S Luisi
- i Department of Molecular and Developmental Medicine, Obstetrics and Gynecology , University of Siena , Siena , Italy
| | - A Maiorana
- a Department of Obstetrics and Gynecology , Civico Hospital , Palermo , Italy
| | - S Makieva
- m Division of Genetics and Cell Biology , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - F Maneschi
- n Department of Obstetrics and Gynecology , San Giovanni Addolorata Hospital , Roma , Italy
| | - F Martire
- k Department of Biomedicine and Prevention , Università degli studi di Roma 'Tor Vergata' , Rome , Italy
| | - C Massarotti
- o Academic Unit of Obstetrics and Gynaecology , Ospedale Policlinico San Martino , Genoa , Italy.,p Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) , University of Genoa , Genoa , Italy
| | - A Mattei
- q Department of Minimally Invasive Gynaecological Surgery , Centre Tuscany USL , Florence , Italy
| | - L Muzii
- h Department of Gynecology, Obstetrics and Urology , ' Sapienza' University of Rome , Rome , Italy
| | - J Ottolina
- d Gynecology Department , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - L Pagliardini
- m Division of Genetics and Cell Biology , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - A Perandini
- e Department of Obstetrics and Gynecology , Azienda Ospedaliera Universitaria Integrata , Verona , Italy
| | - F Perelli
- r Department of Experimental, Clinical and Biomedical Sciences, Obstetrics and Gynaecology , University of Florence , Florence , Italy
| | - I Pino
- s Department of Obstetrics and Gynecology , University of Milan, Macedonio Melloni Hospital , Milan , Italy
| | - M G Porpora
- h Department of Gynecology, Obstetrics and Urology , ' Sapienza' University of Rome , Rome , Italy
| | - V Remorgida
- o Academic Unit of Obstetrics and Gynaecology , Ospedale Policlinico San Martino , Genoa , Italy.,p Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI) , University of Genoa , Genoa , Italy
| | - G Scagnelli
- s Department of Obstetrics and Gynecology , University of Milan, Macedonio Melloni Hospital , Milan , Italy
| | - R Seracchioli
- t Gynecology and Physiopathology of Human Reproductive Unit , University of Bologna, S. Orsola-Malpighi Hospital of Bologna , Bologna , Italy
| | - E Solima
- s Department of Obstetrics and Gynecology , University of Milan, Macedonio Melloni Hospital , Milan , Italy
| | - E Somigliana
- f Department of Clinical Sciences and Community Health , Università degli Studi di Milano , Milan , Italy.,g Gynaecology Unit , Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - G Sorrenti
- k Department of Biomedicine and Prevention , Università degli studi di Roma 'Tor Vergata' , Rome , Italy
| | - A Ticino
- h Department of Gynecology, Obstetrics and Urology , ' Sapienza' University of Rome , Rome , Italy
| | - R Venturella
- j Department of Clinical and Experimental Medicine, Obstetrics and Gynecology , Università degli Studi Magna Graecia , Catanzaro , Italy
| | - P Viganò
- m Division of Genetics and Cell Biology , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - M Vignali
- s Department of Obstetrics and Gynecology , University of Milan, Macedonio Melloni Hospital , Milan , Italy
| | - F Zullo
- u Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine , University of Naples Federico II , Naples , Italy
| | - E Zupi
- k Department of Biomedicine and Prevention , Università degli studi di Roma 'Tor Vergata' , Rome , Italy
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17
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Arata R, Takakura Y, Ikeda S, Itamoto T. A case of ileus caused by ileal endometriosis with lymph node involvement. Int J Surg Case Rep 2018; 54:90-94. [PMID: 30562695 PMCID: PMC6297261 DOI: 10.1016/j.ijscr.2018.11.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 11/26/2018] [Indexed: 01/07/2023] Open
Abstract
A definitive preoperative diagnosis of intestinal endometriosis is challenging. Intestinal endometriosis should be considered when examining premenopausal women. Surgery should be considered in patients presenting with intestinal obstruction.
Introduction Endometriosis is characterized by the presence of endometrial tissue outside the uterus. However, the presence of endometriotic lesions in extrauterine locations at the terminal ileum is unusual and a preoperative diagnosis of intestinal endometriosis has proved challenging. Presentation of case A 49-year-old woman visited a local hospital complaining chiefly of vomiting. Computed tomography (CT) revealed an intestinal obstruction, and she was subsequently referred to and admitted to our hospital. After insertion of an ileus tube and contrast infusion, a crab-like stenosis was observed at the end of the ileum. Although its cause was unknown, we believed this stenosis to be the source of obstruction. Another CT at our hospital showed findings of obstructive ileus with a beak sign at the proximal ileum. Laparoscopic examination was performed to investigate the cause of ileus. Since the tumor at the terminal ileum was suspected to be malignant, we converted to laparotomy and performed an ileocecal excision with lymph node dissection. Based on the intraoperative pathological examination, a diagnosis of endometriosis was suspected. Another mass was found in the rectum but we ended the operation at this point. Postoperatively, the patient was referred to a gynecologist for the management of endometriosis. She was discharged on postoperative day 9 without significant complications. Conclusion The non-specific preoperative clinical and radiological findings of ileal endometriosis make it difficult to distinguish it from other diseases. Although rare, ileal endometriosis should be considered as a differential diagnosis of intestinal obstruction in women of reproductive age.
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Affiliation(s)
- Ryosuke Arata
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Japan
| | - Yuji Takakura
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Japan.
| | - Satoshi Ikeda
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Japan
| | - Toshiyuki Itamoto
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Japan; Department of Gastroenterological and Transplant Surgery Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Japan
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18
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Ekladious A, Wheeler LP, Yamanaka M. Gastrografin: a diagnostic and therapeutic agent. Intern Med J 2018; 48:1547-1549. [PMID: 30517994 DOI: 10.1111/imj.14125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 01/24/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Adel Ekladious
- General Medicine and Hepatology Department, Goulburn Valley Health, Shepparton, Victoria, Australia
| | - Luke P Wheeler
- TMO Unit, Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Mai Yamanaka
- Griffith University, Gold Coast, Queensland, Australia
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19
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A case report: Rectal endometriosis mimicking rectal cancer. Int J Surg Case Rep 2018; 53:137-139. [PMID: 30391739 PMCID: PMC6216069 DOI: 10.1016/j.ijscr.2018.10.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/24/2018] [Accepted: 10/12/2018] [Indexed: 01/07/2023] Open
Abstract
Rectal endometriosis and rectal cancer share many common Imaging characteristics. Small specimen is sometimes insufficient to make a correct diagnosis. Doctors should always pay attention on differential diagnoses.
Introduction: Rectal endometriosis is rare in women and imaging characteristics are similar with that of rectal cancer, which is one of the most common malignancies. Presentation of case: A 36 years old woman with a suspicious diagnosis of cervical carcinoma in a tertiary hospital visited our hospital, complaining about vaginal bleeding after copulation for six months, accompanying with constipation and diameter-thinning stool. Vaginal and cervical biopsy only showed chronic inflammation. Colonoscopy found a mass at the rectum 4 cm from the anus, but the biopsy showed different diagnoses. Partial resection was eventually operated and the final diagnosis was confirmed as rectal endometriosis. Discussion: Rectal endometriosis is prone to be misdiagnosed as rectal cancer. Small specimen is sometimes insufficient to make a correct diagnosis. Extensive examination should be done to confirm the diagnosis and rash decision should never be encouraging. Conclusion: Rectal endometriosis should always be considered as one of the differential diagnoses in female who have a mass at the rectum. An adequate specimen should be obtained to confirm the histopathological diagnosis.
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20
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Sarofim M, Attwell-Heap A, Trautman J, Kwok A, Still A. Unusual case of acute large bowel obstruction: endometriosis mimicking sigmoid malignancy. ANZ J Surg 2018; 89:E542-E543. [PMID: 30277298 DOI: 10.1111/ans.14869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/08/2018] [Accepted: 08/23/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Mina Sarofim
- Department of Colorectal Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia.,The University of New South Wales, Sydney, New South Wales, Australia
| | - Abigail Attwell-Heap
- Department of Colorectal Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Jodie Trautman
- Department of Colorectal Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Allan Kwok
- Department of Colorectal Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Andrew Still
- Department of Colorectal Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia
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21
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Lin TJ, Chang TA, Ting CT, Lin CL, Chen KY. Sigmoid colonic endometriosis mimicking colon cancer: A case report. ADVANCES IN DIGESTIVE MEDICINE 2018. [DOI: 10.1002/aid2.13072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Tsung-Jung Lin
- Department of Gastroenterology; Ren-Ai Branch, Taipei City Hospital; Taipei Taiwan
- Department of Health Promotion and Gerontological Care; Taipei University of Marine Technology; New Taipei City Taiwan
| | - Ting-An Chang
- Department of Pathology; Ren-Ai Branch, Taipei City Hospital; Taipei Taiwan
| | - Chin-Tsung Ting
- Department of Gastrointestinal Surgery; Ren-Ai Branch, Taipei City Hospital; Taipei Taiwan
| | - Chih-Lin Lin
- Department of Gastroenterology; Ren-Ai Branch, Taipei City Hospital; Taipei Taiwan
| | - Kuan-Yang Chen
- Department of Gastroenterology; Ren-Ai Branch, Taipei City Hospital; Taipei Taiwan
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22
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Chan DL, Chua D, Ravindran P, Perez Cerdeira M, Mor I. A case report of endometriosis presenting as an acute small bowel obstruction. Int J Surg Case Rep 2017; 41:17-19. [PMID: 29024840 PMCID: PMC5742011 DOI: 10.1016/j.ijscr.2017.09.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 09/28/2017] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Endometriosis is a common and benign condition that causes significant morbidity to women of childbearing age. It uncommonly affects the gastrointestinal tract and rarely manifests as an acute small bowel obstruction. PRESENTATION OF CASE A 46-year old female presented to the emergency department with signs and symptoms consistent with an acute small bowel obstruction. She had a paucity of background surgical history, having only had a laparoscopic cholecystectomy. Her CT demonstrated small bowel obstruction with a transition point in the distal ileum. Given the site of obstruction was remote from previous surgery, a high index of suspicion was maintained and early laparoscopy performed the same day. Operative findings were consistent with an endometrial stricture of the distal ileum and a formal resection was performed. DISCUSSION Endometriosis that affects the gastrointestinal tract often presents with non-specific symptoms. This is a rare case of an acute small bowel obstruction as the index symptom of endometriosis in a peri-menopausal patient. This is the first case in the literature to describe same day laparoscopy and small bowel resection of such a case and a prolonged preoperative period and misdiagnoses previously described were avoided due to clinical suspicion. CONCLUSION Endometriosis as a differential should be considered with a high index of suspicion in pre-menopausal women, particularly in patients with negligible previous surgical history. There should be a low threshold for early laparoscopy and resection of affected bowel in these patients.
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Affiliation(s)
- Daniel L Chan
- Department of Surgery, The Tweed Hospital, Tweed Heads, NSW, Australia; The Faculty of Medicine, University of New South Wales, Australia.
| | - Dorothy Chua
- Department of Surgery, The Tweed Hospital, Tweed Heads, NSW, Australia
| | - Praveen Ravindran
- Department of Surgery, The Tweed Hospital, Tweed Heads, NSW, Australia
| | | | - Isabella Mor
- Department of Surgery, The Tweed Hospital, Tweed Heads, NSW, Australia
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23
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Vlckova D, Lenz J, Chvatal R, Tihon J, Kavka M, Uncapher L. Endometriosis with an aberrant immunophenotype: Challenging differential diagnosis of glandular lesions in the pelvic lymph nodes. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2017; 161:407-412. [PMID: 28839333 DOI: 10.5507/bp.2017.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 07/11/2017] [Indexed: 11/23/2022] Open
Abstract
CASE REPORT We describe an unusual case of pelvic lymph node endometriosis with an aberrant immunophenotype mimicking metastasis of adenocarcinoma. A 37-year-old patient with a history of invasive cervical adenocarcinoma stage pT1a2 is presented. Due to insufficient loop electrosurgical excision procedure (LEEP) conization, total laparoscopic hysterectomy with pelvic lymphadenectomy was indicated. Intraoperatively, the diagnosis of deep infiltrating endometriosis of parametrial ligament and vesicouterine pouch, endometrioma of the left ovary and Allen Master's syndrome was suspected; the patient had no history or clinical symptoms of endometriosis. A PubMed search of similar cases was followed by a comparison to this case and discussion of the differential diagnosis of glandular lesions in the pelvic lymph nodes is reported. RESULTS Histological investigation showed no residual neoplasia; the diagnosis of endometriosis was confirmed. An interesting microscopic finding was represented by a solitary glandular lesion in one pelvic lymph node. Using immunohistochemistry, it was demonstrated that there was a complete loss of oestrogen and progesterone receptor expression (unlike parametrial ligament endometriosis). The diagnosis of endometriosis was based on the presence of endometrial stroma; malignancy was excluded by bland cytomorphologic features and results of immunohistochemical examination. CONCLUSIONS This type of aberrant of the endometriotic gland immunophenotype has never been presented in the scientific literature before. This finding plays a significant role from the pathology standpoint and, perhaps more importantly, from the clinical standpoint. An asymptomatic patient with a correct diagnosis of lymph node endometriosis did not undergo excessive treatment for false positive diagnosis of metastatic cervical adenocarcinoma.
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Affiliation(s)
- Dita Vlckova
- Department of Obstetrics and Gynaecology, Znojmo Hospital, Czech Republic
| | - Jiri Lenz
- Department of Pathology, Znojmo Hospital, Czech Republic.,Cytohisto s.r.o., Breclav, Czech Republic.,Department of Anatomy, Histology, and Embryology, Faculty of Veterinary Medicine, University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic
| | - Radek Chvatal
- Department of Obstetrics and Gynaecology, Znojmo Hospital, Czech Republic
| | - Jan Tihon
- Department of Surgery, Znojmo Hospital, Czech Republic
| | | | - Lucie Uncapher
- Department of Internal Medicine, Poudre Valley Hospital, Fort Collins, CO, USA Corresponding author: Jiri Lenz, e-mail
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24
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Torres-Rincón RA, Moreno-Rojas A, Salinas-Parra C. Endometriosis en el ciego de una mujer posmenopáusica. Reporte del caso. IATREIA 2017. [DOI: 10.17533/udea.iatreia.v30n3a09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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25
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Laparoscopic Surgery for Colorectal Endometriosis and its Impact upon Fertility: An Updated Australian Series of 307 Cases. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2017. [DOI: 10.5301/jeppd.5000289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction Colorectal involvement occurs in up to 12% of cases of endometriosis. Various surgical options for its management have been described, including segmental resection and disc excision, with debate surrounding indications for surgery and the impact of such procedures. The current study aimed to describe the experiences of three Australian gynaecologists regarding laparoscopic bowel surgery for colorectal endometriosis. Methods The records of three gynaecological surgeons were analysed for patients who underwent surgical removal of colorectal endometriosis by way of appendicectomy, bowel disc excision and/or segmental resection, between 1999 and 2012. Results A total of 307 patients were identified. Sixteen (5.2%) underwent appendicectomy, 146 (47.6%) underwent disc excision, 126 (41.0%) underwent segmental resection and 19 (6.2%) underwent simultaneous procedures. The majority of procedures were performed laparoscopically (265 of 307; 86.3%). Nineteen procedures (6.2%) were planned laparotomies due to the known extent of disease. Twenty-three procedures were converted from laparoscopy to laparotomy (conversion rate of 7.5%). Complications occurred in 35 of the 307 cases (11.4%). Sixty-seven women amongst the 122 wishing to conceive post-operatively achieved at least one pregnancy (pregnancy rate of 54.9%). Of the 84 pregnancies achieved amongst the 67 women who conceived, 49 (58.3%) were achieved through assisted reproductive technologies, and 31 pregnancies (36.9%) were conceived spontaneously. This information was unavailable for 4 pregnancies (4.8%). Conclusions The current series demonstrates that laparoscopic surgery for severe disease is feasible in specialised centres. Furthermore, such surgery may have a positive impact upon post-operative fertility.
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26
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López Carrasco A, Hernández Gutiérrez A, Hidalgo Gutiérrez PA, Rodríguez González R, Marijuán Martín JL, Zapardiel I, de Santiago García J. Ileocecal endometriosis: diagnosis and management. Taiwan J Obstet Gynecol 2017; 56:243-246. [DOI: 10.1016/j.tjog.2016.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2016] [Indexed: 02/07/2023] Open
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27
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Bratu D, Chicea R, Ciprian T, Beli L, Dan S, Mihetiu A, Adrian B. A rare case of ileus caused by ileum endometriosis. Int J Surg Case Rep 2016; 26:24-6. [PMID: 27434884 PMCID: PMC4954939 DOI: 10.1016/j.ijscr.2016.06.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 06/14/2016] [Accepted: 06/14/2016] [Indexed: 01/07/2023] Open
Abstract
We experience a case of relatively rare small bowel obstruction caused by terminal ileum endometriosis. Multiple lesions were also located in Douglas pouch, causing partial rectal stenosis. Correct surgical and medical approach is required.
Introduction We report our experience involving a rare case of ileum endometriosis complicated with small bowel obstruction. Presentation of case 33 years old female patient, admitted to emergency service with abdominal pain, abdominal distension, and vomiting. Abdominal X-ray showed dilated small bowel loops. Computerized tomography scan showed dilated small intestine segments excepting last ileum loop, gastric distension, enlarged ovaries. Emergency laparotomy was performed, showing acute bowel obstruction due to a stenotic tumor placed on the terminal ileum, cecum tumors, multiple tumors in Douglas pouch, multiple mesenteric enlarged lymph nodes. Right colectomy is performed with an ileo-transverso stomy placed in right hypochondrium. Postoperative evolution without complication, patient discharged after 13-days hospitalization. After hormonal treatment, she returned for a second look and ileotransverso anastomosis. Discussion Gastrointestinal involvement of endometriosis has been found in 3%–37% of menstruating women. Ileum localization is very rare (1%–7%), causing intestinal obstruction 7%–23% of cases. Intraoperative differential diagnosis is difficult, predisposing at confusion with other types of tumors. In the absence of fast microscopic exam, the tumor was considered malignant and imposed a right hemicolectomy. Conclusion Intestinal obstruction due to ileum endometriosis is a rare condition, however, it should always be considered in the differential diagnosis in women of reproductive age.
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Affiliation(s)
- Dan Bratu
- Lucian Blaga University-Faculty of Medicine Sibiu, Second Surgery Clinic Academic Emergency Hospital Sibiu Romania, Romania
| | - Radu Chicea
- Lucian Blaga University-Faculty of Medicine Sibiu, Obstetrics and Gynecology Clinic Academic Emergency Hospital Sibiu Romania, Romania.
| | - Tanasescu Ciprian
- Lucian Blaga University-Faculty of Medicine Sibiu, First Surgery Clinic Academic Emergency Hospital Sibiu Romania, Romania
| | - Laurentiu Beli
- Lucian Blaga University-Faculty of Medicine Sibiu, Second Surgery Clinic Academic Emergency Hospital Sibiu Romania, Romania
| | - Sabau Dan
- Lucian Blaga University-Faculty of Medicine Sibiu, Second Surgery Clinic Academic Emergency Hospital Sibiu Romania, Romania
| | - Alin Mihetiu
- Lucian Blaga University-Faculty of Medicine Sibiu, Second Surgery Clinic Academic Emergency Hospital Sibiu Romania, Romania
| | - Boicean Adrian
- Lucian Blaga University-Faculty of Medicine Sibiu, First Medical Clinic Academic Emergency Hospital Sibiu Romania, Romania
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Arer IM, Yabanoglu H, Hasbay B. Anastomotic Leakage in a Patient with Acute Intestinal Obstruction Secondary to Appendiceal and Ileal Endometriosis: A Case Report. J Clin Diagn Res 2016; 10:PD21-2. [PMID: 27190890 DOI: 10.7860/jcdr/2016/18530.7660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 02/15/2016] [Indexed: 11/24/2022]
Abstract
Endometriosis is a commonly encountered problem in women of reproductive age. It usually causes chronic abdominal pain. However, it rarely causes complications such as intestinal obstruction. The most commonly performed procedure for these patients is bowel resection and anastomosis. Unless it is complicated with anastomotic leakage. We present a 39-year-old woman presented with intestinal obstruction due to appendiceal and ileal endometriosis complicated with anastomotic leakage after surgery.
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Affiliation(s)
- Ilker Murat Arer
- Department of General Surgery, Baskent University Adana Teaching and Research Center , Adana, Turkey
| | - Hakan Yabanoglu
- Assistant Professor, Department of General Surgery, Baskent University Adana Teaching and Research Center , Adana, Turkey
| | - Bermal Hasbay
- Department of Pathology, Baskent University Adana Teaching and Research Center , Adana, Turkey
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29
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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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30
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Al-Qahtani HH, Alfalah H, Al-Salamah RA, Elshair AA. Sigmoid colon endometriotic mass. A rare cause of complete large bowel obstruction. Saudi Med J 2015; 36:630-3. [PMID: 25935187 PMCID: PMC4436763 DOI: 10.15537/smj.2015.5.11268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 03/16/2015] [Indexed: 01/07/2023] Open
Abstract
Large bowel obstruction is a rare complication of gastrointestinal endometriosis. A 32-year-old female patient presented to the emergency department with complaints of diffuse abdominal pain and constipation for 10 days with progressive abdominal distention and vomiting. Plain abdominal x-ray showed grossly dilated large bowel up to the sigmoid colon with no gas in the rectum. Abdominal computed tomography revealed hugely dilated large bowel up to the sigmoid colon, with sigmoid soft tissue mass. Flexible sigmoidoscopy showed a non-ulcerating sigmoid mass, with complete obstruction of the sigmoid colon, which impeded the further advancement of the scope. She underwent exploratory laparotomy with provisional diagnosis of complete large bowel obstruction due to sigmoid tumor. Sigmiodectomy with end colostomy was performed. Histopathology revealed endometrial glands with stroma in muscularis properia of the sigmoid colon mass. Endometriosis should be considered in women of reproductive age presenting with symptoms of large bowel obstruction.
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Affiliation(s)
- Hamad H Al-Qahtani
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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31
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Chen H, Luo Q, Liu S, Xiong H, Jiang Q. Rectal mucosal endometriosis primarily misinterpreted as adenocarcinoma: a case report and review of literature. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:5902-5907. [PMID: 26191316 PMCID: PMC4503187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 04/15/2015] [Indexed: 06/04/2023]
Abstract
Endometriosis involving intestinal mucosa is relatively uncommon. It poses a diagnostic challenge for clinicians and pathologists. We herein report a case of colonoscopic specimen revealing rectal mucosal endometriosis. A 39-year-old woman complained of red rectal bleeding and intermittent abdominal pain. Colonoscopic examination showed a rectal mass with ulceration and circum wall involvement. Biopsy was processed in the suspicious of carcinoma. Morphologically, irregular glands replaced residual colorectal ones, displayed mucin depletion, nuclear stratification and subtile subnuclear vacuoles. The stroma was full of spindle cells with abundant pink cytoplasm and unclear boundary. Due to subjectively interpreting as dysplastic glands in desmoplastic setting, primary rectal adenocarcinoma was firstly raised. Immunohistochemically, CK7, ER and CD10 identified the essence of ectopic endometrium. CK20 and CDX2 highlighted residual glands. In case of misdiagnosis, any pathologists should be aware of intestinal endometriosis for each female's colorectal biopsy, especially for that morphology not typical for primary adenocarcinoma or endometriosis. Reading slides carefully combined with a panel of immunomarkers would solve the pitfall.
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Affiliation(s)
- Hui Chen
- Department of Pathology, The Third Affiliated Hospital, Guangzhou Medical University Guangzhou 510150, China
| | - Qiuping Luo
- Department of Pathology, The Third Affiliated Hospital, Guangzhou Medical University Guangzhou 510150, China
| | - Shaoyan Liu
- Department of Pathology, The Third Affiliated Hospital, Guangzhou Medical University Guangzhou 510150, China
| | - Hanzhen Xiong
- Department of Pathology, The Third Affiliated Hospital, Guangzhou Medical University Guangzhou 510150, China
| | - Qingping Jiang
- Department of Pathology, The Third Affiliated Hospital, Guangzhou Medical University Guangzhou 510150, China
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32
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Terracciano F, Scalisi G, Attino V, Biscaglia G. A rare case of sigmoid colon obstruction in patient with ulcerative colitis: role of transabdominal ultrasound-guided biopsy. J Ultrasound 2014; 18:411-4. [PMID: 26550066 DOI: 10.1007/s40477-014-0105-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 05/26/2014] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Endometriosis is a common chronic gynaecological disease affecting 10 % of women of reproductive age. Of these 5-12 % may present bowel endometriosis that may be asymptomatic or associated with aspecific symptoms even bowel obstruction. CASE PRESENTATION The case of a 41-year-old woman with history of ulcerative colitis, previous diagnosis of ovarian endometriosis, recurrent abdominal pain not related to the menstrual cycle, with abdominal pain and obstinate constipation for 2 weeks was referred. The patient underwent colonoscopy, transabdominal ultrasound and ultrasound-guided fine-needle biopsy to have a diagnosis. DISCUSSION Endometriosis should be considered in the differential diagnosis of every woman of childbearing age who presents with gastrointestinal or abdominal symptoms. As demonstrated in our case and by the burgeoning literature in this field, we believe that the role of transabdominal ultrasound should be reconsidered in the management of abdominal diseases because this examination associated with ultrasound-guided fine-needle biopsy allows, in expert hands, to obtain adequate histological samples avoiding patients to undergo more invasive tests to get a diagnosis.
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Affiliation(s)
- F Terracciano
- U.O.C. Gastroenterology and Digestive Endoscopy, IRRCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - G Scalisi
- U.O. Digestive Endoscopy, Policlinico G. Martino, Messina, Italy
| | - V Attino
- U.O. Pathological Anatomy, IRRCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - G Biscaglia
- U.O.C. Gastroenterology and Digestive Endoscopy, IRRCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
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Multidisciplinary laparoscopic treatment for bowel endometriosis. Best Pract Res Clin Gastroenterol 2014; 28:53-67. [PMID: 24485255 DOI: 10.1016/j.bpg.2013.11.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 10/02/2013] [Accepted: 11/23/2013] [Indexed: 01/31/2023]
Abstract
Endometriosis is a handicapping disease affecting young females in the reproductive period. It mainly occurs in the pelvis and affects the bowel in 3-37%. Endometriosis can cause menstrual and non-menstrual pelvic pain and infertility. Colorectal involvement results in alterations of bowel habit such as constipation, diarrhoea, tenesmus, and rarely rectal bleeding. A precise diagnosis about the presence, location and extent is necessary. Based on clinical examination, the diagnosis of bowel endometriosis can be made by transvaginal ultrasound, barium enema examination and magnetic resonance imaging. Multidisciplinary laparoscopic treatment has become the standard of care and depending on size of the lesion and site of involvement full-thickness disc excision or bowel resection is performed by an experienced colorectal surgeon. Anastomotic complications occur around 1%. Long-term outcome after bowel resection for severe endometriosis is good with a pregnancy rate of 50%.
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34
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Soumekh A, Nagler J. Gastrointestinal endometriosis causing subacute intestinal obstruction with gradual development of weight loss and misdiagnosed as irritable bowel syndrome. Case Rep Gastroenterol 2014; 8:51-5. [PMID: 24574950 PMCID: PMC3934607 DOI: 10.1159/000358552] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Both endometriosis and irritable bowel syndrome (IBS) are commonly found in young women and the diagnosis of either is challenging. Alarm symptoms can exclude the diagnosis of IBS, but their onset may be insidious and often no evidence of organic disease may be found. We present a patient with a 4-year history of presumed IBS, absent gynecological symptoms, negative gastrointestinal as well as gynecological testing who developed the only alarm symptom of weight loss and was eventually found to have endometriosis of the small intestine. This case illustrates the need for constant vigilance in patients with IBS.
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Affiliation(s)
- Amir Soumekh
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medical College, New York, N.Y., USA
| | - Jerry Nagler
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medical College, New York, N.Y., USA
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35
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Management of rectosigmoid obstruction due to severe bowel endometriosis. Updates Surg 2013; 66:59-64. [DOI: 10.1007/s13304-013-0240-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 11/14/2013] [Indexed: 01/07/2023]
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36
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Hsu M, Terris B, Wu TT, Zen Y, Eng HL, Huang WT, Yeh MM. Endometrial cysts within the liver: a rare entity and its differential diagnosis with mucinous cystic neoplasms of the liver. Hum Pathol 2013; 45:761-7. [PMID: 24491354 DOI: 10.1016/j.humpath.2013.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 11/06/2013] [Accepted: 11/08/2013] [Indexed: 01/07/2023]
Abstract
Endometrial cysts within the liver are rare but can present as diagnostic challenges on small biopsies or frozen sections and may mimic mucinous cystic neoplasms (MCN) of the liver. Five cases of endometrial cysts and 6 cases of MCNs within the liver were collected. The clinicopathological, imaging, and immunohistochemical features were systematically reviewed and compared. The average size of the endometrial cysts was 8.3 cm. Four patients had a prior pelvic operation and coexisting endometriosis at other sites. All 5 cases of endometrial cysts had positive ER staining within both the epithelium and the stroma. PR was also positive in both epithelial and stromal cells in 4 cases. Four cases had additional immunostains performed, which all showed cytokeratin 19 and cytokeratin 7 positivity (only in epithelium) and CD10 positivity (only in stroma). α-Inhibin and calretinin were negative for both the epithelium and the stroma in all 4 cases. All 6 MCN cases (mean size, 11.1 cm) had positive ER, PR, and α-inhibin staining only in the stroma. ER and PR were positive in both the epithelium and stromal cells in endometrial cysts, whereas they were positive only in the stromal cells of MCNs. The stromal cells were CD10 positive and α-inhibin negative in endometrial cysts as opposed to the opposite staining pattern in MCNs. Awareness of this distinct staining pattern and the possibility of endometrial cysts in the liver can lead to accurate diagnoses and appropriate treatment modalities.
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Affiliation(s)
- Maylee Hsu
- Department of Pathology, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Benoit Terris
- Service d'Anatomie Pathologique, Hopital Cochin, University Paris Descartes, Paris 75014, France
| | - Tsung-Teh Wu
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | - Yoh Zen
- Histopathology Section, Institute of Liver Studies, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Hock-Liew Eng
- Department of Pathology, Chang-Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Wan-Ting Huang
- Department of Pathology, Chang-Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Matthew M Yeh
- Department of Pathology, University of Washington School of Medicine, Seattle, WA 98195, USA; Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA.
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37
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Endometriosis involving the mucosa of the intestinal tract: a clinicopathologic study of 15 cases. Mod Pathol 2013; 26:1270-8. [PMID: 23579618 DOI: 10.1038/modpathol.2013.51] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 01/14/2013] [Accepted: 01/14/2013] [Indexed: 01/07/2023]
Abstract
Endometriosis involving the mucosa of the intestines is rare, but may lead to diagnostic pitfalls. We reviewed 15 cases (seven biopsies and eight resections) from 14 patients. The patients' mean age is 48 years (31-66 years). Presenting symptoms included lower gastrointestinal bleeding, pelvic pain, rectal urgency, abdominal mass, and bowel obstruction. In the majority of cases, the lesion was located in the rectum (73%) with the remainder in the sigmoid colon (20%) and ileum (7%). The most common indication for biopsy was a polypoid lesion seen endoscopically (eight cases). For patients who underwent resections, the most common clinical impression was colonic carcinoma (75%), due to mass lesions and stricture as the most common macroscopic findings. Histologically, one case had stromal endometriosis only, but the remaining 14 cases had both endometrial glands and stroma. Epithelial metaplasia was present in all cases, mostly tubal metaplasia (ciliated epithelium). Hybrid glands and replacement of the surface epithelium by endometrial epithelium were also seen. Crypt architectural distortion, cryptitis, and crypt abscesses were seen in some cases, mimicking chronic active colitis or enteritis. A panel of immunohistochemical stains (CK7, CK20, CDX2, and ER) was found to be useful in biopsies with suspected endometriosis demonstrating unusual histology or only containing endometrioid stroma tissue. Vascular involvement by endometriosis was identified in one case. Endometrial hyperplasia (n=2) and cancer (n=1) were also seen in the ectopic tissue. All patients were alive at follow-up (3-216 months, mean 67 months).
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38
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Kaemmerer E, Westerkamp M, Kasperk R, Niepmann G, Scherer A, Gassler N. Coincidence of active Crohn's disease and florid endometriosis in the terminal ileum: A case report. World J Gastroenterol 2013; 19:4413-4417. [PMID: 23885155 PMCID: PMC3718912 DOI: 10.3748/wjg.v19.i27.4413] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 03/15/2013] [Accepted: 04/11/2013] [Indexed: 02/06/2023] Open
Abstract
Crohn’s disease (CD), a variant of chronic inflammatory bowel disease, frequently affects the terminal ileum and coecal region. The clinical symptoms are often subtle and depend on the inflammatory activity of disease. In women of child-bearing age, florid intestinal endometriosis can simulate CD. Moreover, current pathophysiological concepts include intestinal endometriosis as a putative founder lesion for consecutive CD establishment. The report summarizes clinical and histomorphological data of a 35-year-old woman with the rare coincidence of florid intestinal endometriosis and CD both affecting the terminal ileum. The patient was suffering over 10 years from strong abdominal disorders including constipation, diarrhea, weight loss, and diffuse abdominal pain. In magnetic resonance imaging-Sellink, strong inflammation and intestinal obstruction of the terminal ileum were found. The laparoscopy revealed further evidence for existence of an inflammatory disease like CD, but brownish spots on the peritoneum were found indicative for endometriosis. Surgical resection of the terminal ileum and the coecal segment was performed followed by histopathological investigations. In transmural sections of the terminal ileum, histomorphological features of florid endometriosis intermingled with florid CD was found. The diagnostic findings were substantiated with a panel of immunohistological stainings. In conclusion, the findings demonstrate that florid endometriosis persists in florid CD lesions and the putative link between intestinal endometriosis and CD is more complex than previously assumed.
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39
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Tong YL, Chen Y, Zhu SY. Ileocecal endometriosis and a diagnosis dilemma: A case report and literature review. World J Gastroenterol 2013; 19:3707-3710. [PMID: 23801877 PMCID: PMC3691027 DOI: 10.3748/wjg.v19.i23.3707] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 03/20/2013] [Accepted: 04/28/2013] [Indexed: 02/06/2023] Open
Abstract
Bowel endometriosis affects between 3.8% and 37% of women with endometriosis. The evaluation of symptoms and clinical examination are inadequate for an accurate diagnosis of intestinal endometriosis. We describe the case of a 41-year-old woman who presented to our hospital because of six months of recurrent abdominal pain, vomiting and diarrhea, without previous history of bowel disease. Physical examination revealed a palpable 3 cm × 5 cm mass in the right lower quadrant abdomen. Laboratory tests showed slightly elevated levels of CA19-9 and CA125. Small bowel computer tomography scanning revealed an ileocecal mass with bowel wall thickening and luminal narrowing. Small bowel endoscopy identified a deep longitudinal ulcer and mucosal edema in the distal ileum. All these findings supported the diagnosis of Crohn’s disease. The patient underwent a laparotomy, which identified a 5 cm × 5 cm ileocecal mass with severe mucosal edema and luminal stricture in the distal ileum. Histopathological examination confirmed a diagnosis of ileocecal endometriosis without other areas involved. After one-year follow-up, there was no recurrence of the symptoms.
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40
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Colonic obstruction as an unusual presentation of endometrioma: a case report. Surg Laparosc Endosc Percutan Tech 2013; 23:e131-3. [PMID: 23752022 DOI: 10.1097/sle.0b013e318278e87a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Endometriosis usually occurs in the pelvis but can be found nearly anywhere in the body. Bowel involvement in endometriosis is uncommon and it is estimated to be present in 3.7% to 35% of women with endometriosis. It can rarely result in intestinal obstruction. Here, we present a synchronous localization of endometriosis, ovarian and intestinal, resulting in chronic gastrointestinal symptoms and colonic obstruction in a 33-year-old woman.
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41
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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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42
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Endometriosis of the terminal ileum: a diagnostic dilemma. Case Rep Pathol 2012; 2012:742035. [PMID: 22997597 PMCID: PMC3446655 DOI: 10.1155/2012/742035] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 08/21/2012] [Indexed: 12/15/2022] Open
Abstract
Endometriosis is characterized by the presence of endometrial tissue consisting of glands and/or stroma located outside the uterus. Involvement of the terminal ileum is extremely rare. Preoperative distinction of ileal endometriosis from other diseases of the ileocecal region is difficult in terms of clinical presentation, symptomatology, radiological appearance, and surgical and pathological findings. We report a case initially diagnosed as Crohn's disease due to a longstanding diarrhea with subsequent intestinal obstruction, but finally diagnosed as ileal endometriosis by histopathological evaluation after resection of the involved segment.
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43
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Nongynecological endometriosis presenting as an acute abdomen. Emerg Radiol 2012; 19:463-71. [PMID: 22538970 DOI: 10.1007/s10140-012-1048-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Accepted: 04/11/2012] [Indexed: 01/07/2023]
Abstract
Endometriosis is a highly prevalent disease that affects up to 10 % of menstruating women. Patients commonly present with pelvic pain or infertility, although the range of clinical symptoms varies widely. Affected women may be asymptomatic or experience mild, moderate, or severe pain that fluctuates with hormonal cycles. Patients who suffer extreme pain may seek immediate care and present to the emergency department with clinical signs of an acute abdomen. In the case of patients without a prior history of endometriosis, the differential diagnosis is broad and making the correct clinical and radiologic diagnosis in the emergency setting can be challenging. In some cases, the diagnosis is only made after surgical or histopathological analysis. Prompt and accurate clinical and radiological evaluation is necessary because complications of endometriosis, such as bowel obstruction and appendicitis, may require immediate surgical intervention. This pictorial essay analyzes nongynecological manifestations of endometriosis that may have a clinical presentation of an acute abdominal emergency. Atypical clinical presentations and unusual sites and complications of endometriosis are discussed, as well as the differential diagnostic considerations. The radiologic features of endometriosis are shown on multiple modalities, including computed tomography, magnetic resonance imaging, and ultrasound.
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44
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Nasr JY, Lloyd J, Yadav D. An unusual cause of fibrostenotic terminal ileal disease. Gastroenterology 2011; 141:e5-6. [PMID: 21787774 DOI: 10.1053/j.gastro.2010.05.098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Accepted: 05/12/2010] [Indexed: 01/07/2023]
Affiliation(s)
- John Y Nasr
- Departments of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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45
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Obstrucción intestinal secundaria a endometriosis. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2011. [DOI: 10.1016/j.gine.2009.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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46
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Murji A, Sobel ML. Bowel obstruction and pelvic mass. CMAJ 2011; 183:686-9. [PMID: 21149525 PMCID: PMC3071390 DOI: 10.1503/cmaj.091851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Ally Murji
- From the Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ont
| | - Mara L. Sobel
- From the Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ont
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González-Pezzat I, Soto-Pérez-de-Celis E, García-Lascurain JL. Bowel Endometriosis as an Unusual Cause of Rectal Bleeding. Am Surg 2011. [DOI: 10.1177/000313481107700233] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Montalto M, Santoro L, D'Onofrio F, Gallo A, Campo S, Campo V, Gasbarrini A, Gasbarrini G. Endometriosis, need for a multidisciplinary clinical setting: the internist's point of view. Intern Emerg Med 2010; 5:463-7. [PMID: 20449690 DOI: 10.1007/s11739-010-0404-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Accepted: 04/13/2010] [Indexed: 01/07/2023]
Abstract
Endometriosis is a common condition characterized by proliferation of endometrial tissue outside the uterus, both in the pelvis and in other extra-pelvic sites. The clinical picture of endometriosis is widely heterogeneous. A correct diagnostic work-up of these patients can sometimes be very difficult, since there are a number of gynecological, intestinal and systemic diseases mimicking endometriosis, as well as other conditions that could be associated with or are a consequence of this disorder. Therefore, multidisciplinary care should be encouraged to ensure correct evaluation and improve the management of these patients.
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Affiliation(s)
- Massimo Montalto
- Institute of Internal Medicine, Catholic University, Largo Agostino Gemelli 8, 00168 Rome, Italy.
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Ruffo G, Stepniewska A, Crippa S, Serboli G, Zardini C, Steinkasserer M, Ceccaroni M, Minelli L, Falconi M. Laparoscopic ileocecal resection for bowel endometriosis. Surg Endosc 2010; 25:1257-62. [PMID: 20848137 DOI: 10.1007/s00464-010-1354-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Accepted: 08/26/2010] [Indexed: 02/06/2023]
Abstract
BACKGROUND Ileocecal endometriosis is a very rare entity, and its diagnosis is usually made during surgery for other endometriosis sites or, rarely, because of direct complications of ileal involvement. This study was designed to analyze perioperative and long-term outcomes after bowel resection for ileocecal endometriosis. METHODS All patients who underwent surgery for ileocecal endometriosis between October 2004 and January 2008 were prospectively collected and analyzed. RESULTS Thirty-one women (median age, 34 (range, 25-40) years) were identified. Ileocecal endometriosis was diagnosed during surgery in all patients, and it was associated with colorectal endometriosis in 29 patients (94%). All patients underwent laparoscopic ileocecal resection with no laparotomic conversion. Rectosigmoid or rectal resections was associated in 28 patients (90%) and nodulectomy for sigmoid endometriosis in 1 patient. Median duration of surgery was 301 (range, 90-480) min. Other associated surgical procedures included total hysterectomy (n = 3, 14%), ureterolysis (n = 7, 23%), excision of vesical (n = 4, 13%), vaginal (n = 8, 26%), and parametrial (n = 3, 14%) nodules. There was no mortality. Four patients (13%) required blood transfusions and one a reoperation for bleeding. In a patient who performed ureterolysis, a ureteral fistula occurred. The median hospital stay was 7 (range, 5-18) days. Long-term (>12 months) follow-up data were available for 18 patients. After a median follow-up of 27 months, in 12 of 18 patients (67%) defecation after surgery was normal. Only one patient developed recurrence, which is under medical treatment. CONCLUSIONS Laparoscopic ileocecal resection is safe and feasible and should be considered as part of surgery for endometriosis with radical intent.
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Affiliation(s)
- Giacomo Ruffo
- Department of Surgery, Ospedale Sacro Cuore, Via Sempreboni, 5, 37024 Negrar, VR, Italy.
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Slesser AA, Sultan S, Kubba F, Sellu DP. Acute small bowel obstruction secondary to intestinal endometriosis, an elusive condition: a case report. World J Emerg Surg 2010; 5:27. [PMID: 20846366 PMCID: PMC2949747 DOI: 10.1186/1749-7922-5-27] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2010] [Accepted: 09/16/2010] [Indexed: 12/19/2022] Open
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.
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Affiliation(s)
- Alistair Ap Slesser
- Department of Surgery, Ealing Hospital, Uxbridge Road, Southall, Middlesex, UK.
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