A Case of Ileal Endometriosis with Small Bowel Obstruction and Cardiac Arrest Caused by Ventricular Tachycardia During Surgery

Abstract

We report of a case of ileal endometriosis with small bowel obstruction (SBO). A47-year-old woman referred for lower abdominal pain on May 29, 1999, underwent intestinal tract decompression with a long intestinal tube. Enterography showed no remarkable stenotic lesions in the small intestine and small bowel movement was notably slow. Abdominal computed tomography showed a cystic mass near the uterus and intestinal dilation in the lower abdomen. Emergency laparotomy was done under a preoperative diagnosis of rupture of the left ovarial cyst with paralytic ileus. We found a rupture of a left chocolate cyst and flexions, adhesions, and intestinal wall thickness in the ileum. During surgery, she suffered cardiac arrest followed by ventricular tachycardia (VT), but recovered completely immediately after prompt resuscitation. We segmentally resected the ileum. The lesion was diagnosed pathologically as ileal endometriosis. Hypokalemia caused by severe diarrhea was thought to be the main reason for VT occurred during surgery. Her postoperative course was uneventful and she was discharged on postoperative day 19. It is very difficult to diagnose endometriosis of the small intestine preoperatively because this disease rarely involves the small intestine or SBO. This disease must be kept in mind, however, when a woman is diagnosed with ileus origin.