Abstract
A 36-year-old woman without previous medical history visited a hospital because of abdominal pain after dinner on the first day of her menstrual cycle and further intensifying abdominal pain and vomiting on the next day. Abdominal CT scan revealed bloody ascites and dilatation of the small intestine. She was referred to the department of gynecology in our hospital, but no gynecological abnormalities were found. Then she was referred to our department of surgery with a diagnosis of small bowel obstruction. There were tenderness and rebound tenderness in the right lower quadrant of abdomen. Abdominal X-ray showed intestinal obstruction.
Abdominal CT scan offered a diagnosis of intestinal obstruction due to a tumorous lesion in the vicinity of the distal ileum. An emergency surgery was thus performed with a preoperative diagnosis of small bowel obstruction. At operation, marked fibrosis of the terminal ileum causing obstruction and bloody ascites were identified. Several fibrotic changes were also seen on the proximal intestine to the lesion and so Crohn disease was diagnosed. Ileocecal resection was performed and the excised specimen proved to be a submucocsal tumor. The histopathological diagnosis was intestinal endometriosis. Intestinal obstruction in this case was considered to be caused by ileal atricture due to ectopic endometriosis. Intestinal obstruction caused by ileal endometriosis is a rare entity, but we must keep it in mind as a differential diagnosis of intestinal obstruction in mature female patients. We also present a review of 41 cases of intestinal obstruction caused by endometriosis reported in the Japanese literature.
