Case Report
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World J Gastroenterol. Jun 21, 2013; 19(23): 3707-3710
Published online Jun 21, 2013. doi: 10.3748/wjg.v19.i23.3707
Ileocecal endometriosis and a diagnosis dilemma: A case report and literature review
Yu-Ling Tong, Yan Chen, Shen-Yi Zhu
Yu-Ling Tong, Department of Gastroenterology, Hangzhou Binjiang Hospital, the 2nd Affiliated Hospital of Zhejiang University (Binjiang Branch), School of Medicine, Hangzhou 310000, Zhejiang Province, China
Yan Chen, Shen-Yi Zhu, Department of Gastroenterology, the 2nd Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
Author contributions: Tong YL substantially contributed to study conception and design, and drafting of the article; Zhu SY contributed to analysis of the image information and pathological examinations; Chen Y substantially contributed to critical revision of the article for important intellectual content, and approved the final version to be published.
Correspondence to: Yan Chen, MD, PhD, Department of Gastroenterology, the 2nd Affiliated Hospital of Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou 310009, Zhejiang Province, China. chenyan72_72@hotmail.com
Telephone: +86-571-87784679 Fax: +86-571-87767118
Received: February 4, 2013
Revised: March 27, 2013
Accepted: April 27, 2013
Published online: June 21, 2013
Abstract

Bowel endometriosis affects between 3.8% and 37% of women with endometriosis. The evaluation of symptoms and clinical examination are inadequate for an accurate diagnosis of intestinal endometriosis. We describe the case of a 41-year-old woman who presented to our hospital because of six months of recurrent abdominal pain, vomiting and diarrhea, without previous history of bowel disease. Physical examination revealed a palpable 3 cm × 5 cm mass in the right lower quadrant abdomen. Laboratory tests showed slightly elevated levels of CA19-9 and CA125. Small bowel computer tomography scanning revealed an ileocecal mass with bowel wall thickening and luminal narrowing. Small bowel endoscopy identified a deep longitudinal ulcer and mucosal edema in the distal ileum. All these findings supported the diagnosis of Crohn’s disease. The patient underwent a laparotomy, which identified a 5 cm × 5 cm ileocecal mass with severe mucosal edema and luminal stricture in the distal ileum. Histopathological examination confirmed a diagnosis of ileocecal endometriosis without other areas involved. After one-year follow-up, there was no recurrence of the symptoms.

Keywords: Ileus, Bowel obstruction, Longitudinal ulcer, Crohn’s disease, Endometriosis

Core tip: We describe the case of a 41-year old woman who had recurrent abdominal pain with vomiting and diarrhea on presentation to our hospital. The results of computer tomography scanning and small bowel endoscopy were strongly suspicious for Crohn’s disease. However, surgery and histopathological examination confirmed a diagnosis of ileocecal endometriosis without other areas involved.