Presentation
The patient was presented with symptoms of intestinal obstruction. She underwent limited laparoscopy, after which her symptoms had not relieved. Then she underwent abdominal CT
Patient Data
diffuse wall thickening of the distal ileal loops
dilatation of the proximal small bowel loops
mild ascites
pneumoperitoneum from recent laparoscopy
nasogastric tube and peritoneal drainage tubes
right side abdominal wall edema
bilateral minimal pleural effusion
incidental left ovarian cyst
The patient went on to have a laparotomy with limited hemicolectomy and extended ileal resection.
Pathology report:
Gross examination:
Received specimen: ileal loop measured 50cm, with thickened part (A). Random cut sections of the ileum (B). The cecal colonic part (D) measured 10cm. Lymph nodes (C).
Microscopic examination:
Examination revealed ileal endometriosis with normal ileal mucosa and underlying endometrial glands and stroma embedded in the ileal wall with surrounding hemorrhage and hemosiderin-laden macrophages. Chronic inflammatory cellular infiltrate admixed with fibrosis. Resection margins are free. No malignancy in the specimen sent.
Diagnosis:
Limited hemicolectomy with extended ileal resection:
ileal endometriosis
free resection margins
no malignancy
Case Discussion
According to the literature, the small bowel is the second most common intestinal site to be affected by endometriosis after rectosigmoid. It can be asymptomatic or can cause symptoms like nausea, vomiting, colic or even intestinal obstruction as in this case.