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1
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Gurluler E, Isik O, Ugras N, Sahin A, Sen M, Yilmazlar T. Intestinal endometriosis amongst other extra-pelvic endometriosis foci presenting as acute/subacute bowel obstruction in women of reproductive age: a retrospective case series study. BMC Surg 2025; 25:12. [PMID: 39773490 PMCID: PMC11706109 DOI: 10.1186/s12893-024-02755-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Accepted: 12/31/2024] [Indexed: 01/11/2025] Open
Abstract
BACKGROUND This study aimed to investigate the prevalence and clinicopathological correlates of intestinal endometriosis, amongst other extra-pelvic endometriosis foci, presenting as bowel obstruction in general surgery practice. METHODS A total of 23 female patients (mean ± SD age: 34.9 ± 6.5 years) who underwent abdominal surgery for acute bowel obstruction and received histopathological diagnosis of endometriosis were included in this retrospective case-series study. Data on patient characteristics, obstetric history, preoperative laboratory and imaging findings, preoperative provisional diagnosis, type of surgical intervention and the pathological diagnosis, and postoperative outcomes were recorded. RESULTS Definitive diagnoses on histopathological work-up involved intestinal endometriosis (52.2%), scar endometriosis (26.0%), ovarian endometriosis (13.0%) and inguinal endometriosis (8.7%). Postoperative complication, reoperation and recurrence rates were 8.7%, 8.7%, and 13.0%, respectively. Intestinal endometriosis, when compared to other extra-pelvic endometriosis foci (scar and inguinal), was associated with significantly higher preoperative platelet counts (332.0(284.0-528.0)vs. 239.0(223.0-370.0) 103/µL, p = 0.010), lower albumin levels (4.0(2.7-4.7) vs. 4.5(4.2-4.9) g/dL, p = 0.029), higher rates of preoperative CT utilization (91.7% vs. 0.0%, p < 0.001) and emergent surgery (83.3% vs. 0.0%, p = 0.001) and longer LOS (median 4.5 (1.0-26.0) vs. 1.0(1.0-1.0) days, p = 0.001) along with a non-significant tendency for higher postoperative complication (16.7% vs. 0.0%) and ICU stay (25.0% vs. 0.0%) rates. CONCLUSION Our findings revealed intestinal endometriosis, predominantly in the terminal ileum/appendix, was the most common extra-pelvic cause of acute bowel obstruction. The scar endometriosis, inguinal endometriosis and ovarian endometriosis appeared to be other potential but less prevalent aetiologies in this setting.
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Affiliation(s)
- Ercument Gurluler
- Department of General Surgery, Uludag University Faculty of Medicine, Bursa, Turkey.
- Department of General Surgery, Uludag University Faculty of Medicine, Bursa, Turkey.
| | - Ozgen Isik
- Department of General Surgery, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Nesrin Ugras
- Department of Pathology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Aysun Sahin
- Department of General Surgery, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Murat Sen
- Department of General Surgery, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Tuncay Yilmazlar
- Department of General Surgery, Uludag University Faculty of Medicine, Bursa, Turkey
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2
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Thirumurthy SK, Mohammed M. A rare case of invasive endometriosis causing intestinal obstruction. J Surg Case Rep 2024; 2024:rjae082. [PMID: 38389510 PMCID: PMC10881289 DOI: 10.1093/jscr/rjae082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 02/04/2024] [Indexed: 02/24/2024] Open
Abstract
A 35-year-old woman presented to the emergency department with severe right iliac fossa pain with features of subacute intestinal obstruction and recurrent episodes of similar pain in the past. CT scan showed a mass with fluid collection with no trace of the appendix in the right iliac fossa. The patient was taken up for a diagnostic laparoscopy and proceeded. Operative findings were that of a mass in the lumen of the terminal ileum just 6 inches from the ileocaecal junction. Normal pelvis with normal uterus and ovaries. The patient underwent a laparoscopic resection of the terminal ileum and limited resection of the ascending colon with an ileo-colic anastomosis. The patient recovered well and was discharged. The biopsy was reported as invasive endometriosis involving the muscularis layer of the terminal ileum with stricture of the terminal ileum with transmural inflammation. The case is being presented for the rarity of invasive endometriosis causing bowel obstruction with a normal pelvis.
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Affiliation(s)
- Sathish K Thirumurthy
- Department of General Surgery, NMC Royal Hospital, Al Ghuwair, Sharjah, United Arab Emirates
| | - Mahsheena Mohammed
- Department of General Surgery, NMC Royal Hospital, Al Ghuwair, Sharjah, United Arab Emirates
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3
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Mușat F, Păduraru DN, Bolocan A, Constantinescu A, Ion D, Andronic O. Endometriosis as an Uncommon Cause of Intestinal Obstruction-A Comprehensive Literature Review. J Clin Med 2023; 12:6376. [PMID: 37835020 PMCID: PMC10573381 DOI: 10.3390/jcm12196376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/20/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
The prevalence of intestinal endometriosis has been estimated to be between 3% and 37% of all endometriosis cases. Cases of intestinal occlusion due to endometriosis foci on the small bowel and on the large bowel are even rarer, with a reported prevalence of 0.1-0.7%. The aim of this literature review was to summarize the available published evidence on the diagnosis, characteristics, and management of intestinal occlusion due to endometriosis. The search on PubMed retrieved 295 records, of which 158 were rejected following a review of the title and abstract. After reviewing the full text, 97 studies met the Population, Intervention, Comparator, Outcomes, and Study (PICOS) criteria and were included in the analysis. The total number of patients with bowel occlusion due to endometriosis included in the studies was 107. The occlusive endometrial foci were localized on the ileum in 38.3% of the cases, on the rectosigmoid in 34.5% of the cases, at the ileocecal junction and the appendix in 14.9% of the cases, and at the rectum in 10.2% of the cases. Only one case reported large bowel obstruction by endometriosis of the hepatic flexure of the colon extending to the transverse colon (0.9%), and in one case the obstruction was caused by an omental giant endometrioid cyst compressing the intestines. We identified six cases of postmenopausal females with acute bowel obstruction due to endometriosis. Malignant degeneration of endometriosis was also identified as a cause of intestinal occlusion. The mechanisms of obstruction include the presence of a mass in the lumen of the intestine or in the wall of the intestine, extrinsic compression, adhesions, or intussusception.
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Affiliation(s)
- Florentina Mușat
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, The University Emergency Hospital of Bucharest, 050098 Bucharest, Romania; (F.M.); (A.B.); (D.I.); (O.A.)
| | - Dan Nicolae Păduraru
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, The University Emergency Hospital of Bucharest, 050098 Bucharest, Romania; (F.M.); (A.B.); (D.I.); (O.A.)
| | - Alexandra Bolocan
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, The University Emergency Hospital of Bucharest, 050098 Bucharest, Romania; (F.M.); (A.B.); (D.I.); (O.A.)
| | - Alexandru Constantinescu
- Gastroenterology Department, Carol Davila University of Medicine and Pharmacy, The University Emergency Hospital of Bucharest, 050098 Bucharest, Romania;
| | - Daniel Ion
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, The University Emergency Hospital of Bucharest, 050098 Bucharest, Romania; (F.M.); (A.B.); (D.I.); (O.A.)
| | - Octavian Andronic
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, The University Emergency Hospital of Bucharest, 050098 Bucharest, Romania; (F.M.); (A.B.); (D.I.); (O.A.)
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4
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Chiu T, Niranjan N, FitzGerald K. Endometrioma causing recurrent small bowel obstruction in a virgin abdomen-a case report and literature review. J Surg Case Rep 2023; 2023:rjad392. [PMID: 37416495 PMCID: PMC10319765 DOI: 10.1093/jscr/rjad392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/17/2023] [Indexed: 07/08/2023] Open
Abstract
There has been a modest number of cases of bowel obstruction secondary to endometriosis reported. Delays in diagnoses can cause significant morbidity to patients. We describe the case of a 45-year-old female with a 2-year history of recurrent small bowel obstructions (SBOs) without a history of abdominal surgery. She underwent multiple computed tomography scans, and a magnetic resonance enterography, which queried possible terminal ileitis secondary to Crohn's fibro-stenosing disease or a Meckel's diverticulum. Colonoscopy up to TI was normal. Elective laparoscopy showed a cicatrizing small bowel mass in her distal ileum ~15 cm from the TI, which was resected. There were no other findings. Histopathological testing revealed endometriosis. At 2-month post-resection, she remains symptom-free and was referred to gynaecology. Endometriosis causing bowel obstruction should be considered early in female patients, especially those with virgin abdomens. Timely elective laparoscopy is a safe and effective way of diagnosing and treating small bowel obstruction, avoiding an emergency procedure.
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Affiliation(s)
- Tricia Chiu
- Correspondence address. Department of General Surgery, Wagga Wagga Base Hospital, Docker Street Wagga Wagga, NSW 2650, Australia. Tel: +61 (02) 5943 1000; E-mail:
| | - Nithya Niranjan
- Department of Surgery, Wagga Wagga Base Hospital, Docker St Wagga Wagga, NSW 2650, Australia
| | - Kate FitzGerald
- Department of Surgery, Wagga Wagga Base Hospital, Docker St Wagga Wagga, NSW 2650, Australia
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5
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Fink T, Yong WW, Jayasuriya N. Stricturing ileocaecal endometriosis: a rare concurrent aetiology in a patient with Crohn's disease. J Surg Case Rep 2023; 2023:rjac605. [PMID: 36685117 PMCID: PMC9844955 DOI: 10.1093/jscr/rjac605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/11/2022] [Indexed: 01/19/2023] Open
Abstract
A 34-year-old female presented with colicky abdominal pain and symptoms suggestive of subacute small bowel obstruction in the setting of Crohn's disease (CD). She was on maximal medical therapy and had undergone endoscopic balloon dilatation of a terminal ileal stricture on two occasions. Magnetic resonance enterography demonstrated acute inflammation in two segments of the terminal ileum. The patient proceeded to laparoscopic ileocolic resection. The histopathology revealed a segment of stricturing CD with chronic inflammatory change. There was also an unexpected finding of a segment of stricturing ileal disease secondary to endometriosis. Endometriosis affecting the ileum is uncommon, and concurrent CR and endometriosis is very rare. Further research is required to understand whether these two conditions are associated. Here, we present a discussion on the histopathology differences between endometriosis and CD. Clinicians are reminded of these rare concurrent conditions, as the symptomatology may mimic one another, thus impacting the treatment and management.
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Affiliation(s)
- Teagan Fink
- Correspondence address. PO Box 2075, Edithvale, VIC AUS 3196. Tel: +61-0478-766-733; E-mail:
| | - Wei Wei Yong
- Department of Anatomical Pathology, Western Health and Latrobe Regional Health, Dorevitch Pathology, Traralgon, Victoria, Australia
| | - Neil Jayasuriya
- Department of Surgery, Latrobe Regional Health, Traralgon, Victoria, Australia
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6
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Kobayashi K, Yamadera M, Takeo H, Murayama M. Small bowel obstruction caused by appendiceal and ileal endometriosis: a case report. J Surg Case Rep 2022; 2022:rjac282. [PMID: 35721264 PMCID: PMC9200432 DOI: 10.1093/jscr/rjac282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Endometriosis is characterized by the presence of an ectopic endometrial gland. Intestinal endometriosis with small bowel obstruction is uncommon. In this case, a 37-year-old woman with no history of endometriosis presented with a chief complaint of abdominal pain. Computed tomography revealed a distal small bowel obstruction. Surgical intervention was performed because of the emergent abdominal condition and the potential resistance to conservative management. Histopathological examination revealed appendiceal and ileal endometriotic lesions. Preoperative diagnosis was difficult because there were no specific clinical features. Intraoperatively, it is difficult to distinguish intestinal endometriosis and bowel malignancy; thus, oncological resection should be performed.
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Affiliation(s)
- Kazuki Kobayashi
- Department of Surgery, Self-Defence Forces Central Hospital , Setagaya , Japan
| | - Masato Yamadera
- Department of Surgery, Self-Defence Forces Central Hospital , Setagaya , Japan
| | - Hiroaki Takeo
- Department of Diagnostic Pathology, Self-Defence Forces Central Hospital , Setagaya , Japan
| | - Michinori Murayama
- Department of Surgery, Self-Defence Forces Central Hospital , Setagaya , Japan
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7
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Teng TZJ, Thong XR, Lau KY, Balasubramaniam S, Shelat VG. Acute appendicitis-advances and controversies. World J Gastrointest Surg 2021; 13:1293-1314. [PMID: 34950421 PMCID: PMC8649565 DOI: 10.4240/wjgs.v13.i11.1293] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/24/2021] [Accepted: 09/29/2021] [Indexed: 02/06/2023] Open
Abstract
Being one of the most common causes of the acute abdomen, acute appendicitis (AA) forms the bread and butter of any general surgeon's practice. With the recent advancements in AA's management, much controversy in diagnostic algorithms, possible differential diagnoses, and weighing the management options has been generated, with no absolute consensus in the literature. Since Alvarado described his eponymous clinical scoring system in 1986 to stratify AA risk, there has been a burgeoning of additional scores for guiding downstream management and mortality assessment. Furthermore, advancing literature on the role of antibiotics, variations in appendicectomy, and its adjuncts have expanded the surgeon's repertoire of management options. Owing to the varied presentation, diagnostic tools, and management of AA have also been proposed in special groups such as pregnant patients, the elderly, and the immunocompromised. This article seeks to raise the critical debates about what is currently known about the above aspects of AA and explore the latest controversies in the field. Considering the ever-evolving coronavirus disease 2019 situation worldwide, we also discuss the pandemic's repercussions on patients and how surgeons' practices have evolved in the context of AA.
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Affiliation(s)
- Thomas Zheng Jie Teng
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
- Department of Undergraduate Medicine, Lee Kong Chian School of Medicine, Singapore 308232, Singapore
| | - Xuan Rong Thong
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
- Department of Undergraduate Medicine, Lee Kong Chian School of Medicine, Singapore 308232, Singapore
| | - Kai Yuan Lau
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
- Department of Undergraduate Medicine, Lee Kong Chian School of Medicine, Singapore 308232, Singapore
| | | | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
- Department of Undergraduate Medicine, Lee Kong Chian School of Medicine, Singapore 308232, Singapore
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8
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Zula D, Paul DA, Arachchi A, Narasimhan V, Tay YK. Ileal endometriosis: a rare cause of small bowel obstruction in the virgin abdomen. ANZ J Surg 2021; 92:1246-1248. [PMID: 34585496 DOI: 10.1111/ans.17243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/16/2021] [Accepted: 09/18/2021] [Indexed: 11/28/2022]
Affiliation(s)
- David Zula
- Colorectal Unit, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
| | - Dion A Paul
- Colorectal Unit, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
| | - Asiri Arachchi
- Colorectal Unit, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
| | - Vignesh Narasimhan
- Colorectal Unit, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
| | - Yeng Kwang Tay
- Colorectal Unit, Dandenong Hospital, Monash Health, Melbourne, Victoria, Australia
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9
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Ileal obstruction due to endometriosis, with associated appendiceal involvement: A unique and elusive situation. GASTROENTEROLOGIA Y HEPATOLOGIA 2021; 45 Suppl 1:135-136. [PMID: 34118319 DOI: 10.1016/j.gastrohep.2021.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/08/2021] [Indexed: 11/22/2022]
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10
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Santos-Manzur A, Valdez-Bocanegra DR, Ornelas-Flores MC, Pineda-Díaz J, Stoopen-Margain E. Ileal obstruction caused by transmural endometriosis in a patient with simultaneous C. difficile colitis and Influenza AH1N1. Case report. Int J Surg Case Rep 2020; 76:522-525. [PMID: 33207423 PMCID: PMC7596015 DOI: 10.1016/j.ijscr.2020.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/08/2020] [Accepted: 10/08/2020] [Indexed: 11/04/2022] Open
Abstract
Bowel obstruction or intestinal occlusion caused by endometriosis is very rare. Endometriotic nodules induce luminal stenosis and ileal obstruction. Transmural endometriosis infiltrates the four layers of the intestinal wall. Diagnosis is established through pathological and immunohistochemical analysis. The treatment of choice is bowel resection via laparoscopy or laparotomy. Introduction Small bowel obstruction secondary to endometriosis is extremely rare. This etiology is reported in 0.10% of cases and diagnosed incidentally. Case presentation 32-year old female, critically ill patient was diagnosed with small bowel obstruction. After medical stabilization of multiple comorbidities, diagnostic laparoscopy was done and converted to open right ileocolectomy with ileo-transverse anastomosis. Definite diagnosis was ileal obstruction caused by transmural endometriosis. The patient's recovery was uneventful. At one-year follow-up, she remains asymptomatic. Discussion We present the uncommon case of ileal obstruction due to transmural endometriosis that was treated surgically. We also present current literature review focusing on diagnostic and treatment methods of this rare disease. Conclusion Endometriosis should be included in the differential diagnosis of small bowel obstruction. The treatment of choice is bowel resection.
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Affiliation(s)
| | | | | | - Janet Pineda-Díaz
- Department of Surgical and Molecular Pathology, ABC Medical Center, Mexico
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11
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Vercellini P, Sergenti G, Buggio L, Frattaruolo MP, Dridi D, Berlanda N. Advances in the medical management of bowel endometriosis. Best Pract Res Clin Obstet Gynaecol 2020; 71:78-99. [PMID: 32680785 DOI: 10.1016/j.bpobgyn.2020.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 12/29/2022]
Abstract
Endometriosis infiltrating the bowel can be treated medically in accurately selected women not seeking conception and without overt obstructive symptomatology. When the rectosigmoid junction is involved, the probabilities of intestinal symptoms relief, undergoing surgery after treatment failure, and developing bowel obstruction during hormonal treatment are around 70%, 10%, and 1-2%, respectively. When the lesion infiltrates exclusively the mid-rectum, thus in cases of true rectovaginal endometriosis, the probabilities of intestinal symptoms relief and undergoing surgery are about 80% and 3%, respectively. Endometriotic obstructions of the rectal ampulla have not been reported. A rectosigmoidoscopy or colonoscopy should be performed systematically before starting medical therapies, also to rule out malignant tumours arising from the intestinal mucosa. Progestogens are safe, generally effective, well-tolerated, inexpensive, and should be considered as first-line medications for bowel endometriosis. Independently of symptom relief, intestinal lesions should be checked periodically to exclude nodule progression during hormonal treatment.
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Affiliation(s)
- Paolo Vercellini
- Department of Clinical Sciences and Community Health, Università degli Studi, Via Commenda, Milan, Italy; Fondazione Ca' Granda Ospedale Maggiore Policlinico, Via Commenda, 12-20122, Milan, Italy.
| | - Greta Sergenti
- Department of Clinical Sciences and Community Health, Università degli Studi, Via Commenda, Milan, Italy
| | - Laura Buggio
- Fondazione Ca' Granda Ospedale Maggiore Policlinico, Via Commenda, 12-20122, Milan, Italy
| | - Maria Pina Frattaruolo
- Fondazione Ca' Granda Ospedale Maggiore Policlinico, Via Commenda, 12-20122, Milan, Italy
| | - Dhouha Dridi
- Department of Clinical Sciences and Community Health, Università degli Studi, Via Commenda, Milan, Italy; Fondazione Ca' Granda Ospedale Maggiore Policlinico, Via Commenda, 12-20122, Milan, Italy
| | - Nicola Berlanda
- Fondazione Ca' Granda Ospedale Maggiore Policlinico, Via Commenda, 12-20122, Milan, Italy
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12
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Alabbas H, Awidah T, Alhallaq O, Babiker T. Small Bowel Endometriosis; A Case Report and Review of Literature. Ann Med Surg (Lond) 2019; 47:24-26. [PMID: 31641497 PMCID: PMC6796512 DOI: 10.1016/j.amsu.2019.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/22/2019] [Accepted: 09/16/2019] [Indexed: 10/31/2022] Open
Abstract
•Small bowel obstruction has a broad list of diagnosis.•Thorough history and physical examination along with proper imaging is the key in determining the cause.•Endometriosis if diagnosed preoperatively may respond to hormonal therapy.•Laparoscopic exploration may be both diagnostic and therapeutic.•Small Bowel Endometriosis; A Case Report and Review of Literature.
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Affiliation(s)
| | - Tariq Awidah
- International Medical Center, Jeddah, Saudi Arabia
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13
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Zhu MY, Fei FM, Chen J, Zhou ZC, Wu B, Shen YY. Endometriosis of the duplex appendix: A case report and review of the literature. World J Clin Cases 2019; 7:2094-2102. [PMID: 31423443 PMCID: PMC6695541 DOI: 10.12998/wjcc.v7.i15.2094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/18/2019] [Accepted: 06/26/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Duplication of the appendix is an infrequent congenital malformation with a complex classification. The horseshoe appendix is a subtype of the duplex appendix and is rarely reported in the literature. Endometriosis is a common gynecological disease that rarely occurs in the appendix. Moreover, horseshoe appendix combined with endometriosis has not been previously reported. CASE SUMMARY Here, we describe a 44-year-old woman who was admitted with a 1-d history of migratory lower right quadrant pain. Physical examination was consistent with the signs of acute appendicitis. The patient underwent an emergency exploratory laparotomy. The distal tip of the appendix was in contact with the cecum by another base, or "horseshoe appendix". In addition, a small intestinal mass and an ovarian mass were identified. Subsequently, appendectomy, partial resection of the small intestine, and right oophorectomy were successively performed. The histopathology confirmed the diagnosis of acute inflammation of the duplex appendix with endometriosis, small intestine endometriosis, and ovarian endometriosis. CONCLUSION Surgeons need to be aware of the possibility of the duplex appendix when performing an appendectomy, and this study emphasizes the importance of exploring the entire abdomen.
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Affiliation(s)
- Ming-Yuan Zhu
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Fa-Ming Fei
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Jing Chen
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Zhong-Cheng Zhou
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Bin Wu
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Yi-Yu Shen
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
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14
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Choi JDW, Yunaev M. Endometriosis of the appendix causing small bowel obstruction in a virgin abdomen. BMJ Case Rep 2019; 12:12/7/e230496. [PMID: 31337629 DOI: 10.1136/bcr-2019-230496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
A 29-year-old, otherwise well, nulligravid woman presented to the emergency department with 1-day history of generalised abdominal pain and vomiting. She had similar symptoms 6 months prior following recent menstruations, which resolved conservatively. She had no prior history of abdominal surgery or endometriosis. CT scan demonstrated distal small bowel obstruction. A congenital band adhesion was suspected, and she underwent prompt surgical intervention. During laparoscopy, a thickened appendix was adhered to a segment of distal ileum. There was blood in the pelvis. Laparoscopic adhesiolysis and appendicectomy were performed. Histopathology demonstrated multiple foci of endometriosis of the appendix with endometrial glands surrounded by endometrial stroma. Oestrogen receptor and CD10 immunostains highlighted the endometriotic foci. The patient made a good recovery and was referred to a gynaecologist for further management.
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Affiliation(s)
- Joseph Do Woong Choi
- Department of Surgery, Norwest Private Hospital, Sydney, New South Wales, Australia
| | - Michael Yunaev
- Department of Surgery, Norwest Private Hospital, Sydney, New South Wales, Australia
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15
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Bacalbasa N, Balescu I, Filipescu A. Ileocecal Obstruction Due to Endometriosis - A Case Report and Literature Review. In Vivo 2017; 31:999-1002. [PMID: 28882972 PMCID: PMC5656879 DOI: 10.21873/invivo.11160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 08/08/2017] [Accepted: 08/09/2017] [Indexed: 12/29/2022]
Abstract
Endometriosis is a common finding in premenopausal women and a significant number of cases presenting digestive tract involvement at the time of diagnosis. However, most of these patients present pelvic nodules involving the rectosigmoidian junction, other digestive tract segments being less commonly affected. We present the case of a 37-year-old nulliparous woman who presented for diffuse abdominal pain and vomiting; she was diagnosed with complete ileocecal obstruction due to an endometriosis nodule in association with bilateral ovarian endometriosis lesions invading the rectosigmodian wall. A right colectomy with ileocolic anastomosis in association with bilateral cystectomy and rectosigmodian resection was successfully performed. The histopathological examination confirmed the endometriosic origin of the nodules invading the rectosigmodian and ileocecal wall, that was similar to the one described at the level of the ovarian cysts.
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Affiliation(s)
- Nicolae Bacalbasa
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Alexandru Filipescu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- "Elias" Emergency University Hospital, Bucharest, Romania
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