Endometriosis causing recurrent small bowel obstruction

Case contributed by Dr Michael P Hartung

Presentation

Pelvic pain, nausea, and vomiting.

Patient Data

Age: 30
Gender: Female
CT

Initial presentation

Small bowel obstruction with small ascites. Ill-defined transition point in the pelvis. Possible increased thickening/enhancement of small bowel in the pelvis near the transition. 

CT

3 months after presentation

Recurrent small bowel obstruction. Fecalization of the distal small bowel. Small amount of ascites. Similar ill-defined transition point in the pelvis associated with bowel-wall thickening and enhancement. 

CT

4 months after presentation

Small bowel obstruction is mostly resolved. Now mildly dilated, focalized loops of small bowel which transition in the pelvis. Increased thickening and enhancement of a loop of small bowel in the right adnexal/retrouterine region. 

Few small T1 hyperintense foci in both adnexal regions, indicated endometriotic deposits. 

Laparoscopic images show numerous red/purple deposits throughout the pelvis on the serosal surfaces of the small bowel, consistent with endometriosis. This is much more impressive than seen on the MRI. 

Case Discussion

The moral of the story: when you have an unexplained small bowel obstruction in a young female, consider endometriosis. 

After repeated imaging, the ill-defined transition point in the pelvis becomes more apparent as small-bowel thickening and enhancement. This does not appear typical for inflammatory bowel disease, although that would be a consideration in addition to endometriosis. The MRI was much less impressive given the disease burden seen on laparoscopy (confirmed also with biopsy). 

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Case information

rID: 59034
Published: 17th Mar 2018
Last edited: 16th Jul 2018
Inclusion in quiz mode: Included
Institution: Ascension Healthcare

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