Presentation
Nausea, vomiting, abdominal pain.
Patient Data
Dilated small bowel with ill-defined transition point and mild small bowel thickening in the pelvis. Small ascites.
Recurrent small bowel obstruction with long segment fecalized content leading into an ill-defined pelvic transition point with a cluster of thickened small bowel. Small ascites.
No obstruction. Long segment fecalized small bowel leading into an increasingly pronounced thickened and hyperenhancing cluster of small bowel in the pelvis. Small ascites.
Small ascites. Few small T1-hyperintense foci involving both Fallopian tubes/adnexae. Increased T1 signal in the distal small bowel could be due to fecalized contents or blood products related to endometrotic deposits.
Intraoperative photos from small bowel resection showing numerous small foci of hemorrhage related to endometrotic deposits involving the small bowel, ureters, bladder, pelvic ligaments, and adnexa. Final pathology revealed fibrosis with endometriosis in all samples.
Case Discussion
This case highlights the importance of considering endometriosis as a cause of small bowel obstruction in a young female without a surgical history. In this case, the patient had a diagnostic laparoscopy after the 2nd small bowel obstruction which detected endometriosis, and follow-up MRI and CT prior to definitive surgery for small bowel resection. The intraoperative photos illustrate just how extensive and fibrotic endometriosis can be, with areas of tethering and narrowing of the small bowel corresponding to the abnormal appearance on the last CT.
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