Published online Feb 26, 2019. doi: 10.12998/wjcc.v7.i4.441
Peer-review started: November 5, 2018
First decision: December 20, 2018
Revised: January 9, 2019
Accepted: January 26, 2019
Article in press: January 26, 2019
Published online: February 26, 2019
The intestinal endometriosis is a disease that endometrial tissue involves the small or large intestine. Endometriosis is relatively common disease, but intestinal endometriosis is very rare and it is difficult to diagnose preoperatively.
A young woman who was diagnosed with Crohn’s disease and under medical treatment for about 3 years at our hospital had suffered severe abdominal paint at right lower quadrant. We had found severe stricture of terminal ileum at computed tomography (CT) images. We had misdiagnosed her as acute phase of Crohn’s disease, but the pathologic result was intestinal endometriosis. After that, we reviewed similar cases in our institution and identified there was several misdiagnosed cases before operations. We had also searched similar studies, but not enough information was acquired with their clinical characteristics.
We aimed to evaluate the clinical characteristics of misdiagnosed cases before surgery and tried to suggest ways to reduce those cases.
We retrospectively reviewed medical records of patients who had been diagnosed with intestinal endometriosis from their surgical specimens. Fifty patients were identified and 20 cases were excluded because the diagnosis of intestinal endometriosis was made incidentally during surgical resection for other pathologies. A total of 30 patients were included in this study and their clinical characteristics including age, history of abdominal surgery or endometriosis were evaluated. Clinical presentation, CT imaging, endoscopic findings were also evaluated and preoperative diagnosis, locations of lesions, types of bowel surgeries, and combined operations were analyzed.
According to preoperative evaluations, 13 patients (43.3%) had an initial diagnosis of pelvic endometriosis and 17 patients (56.6%) were misdiagnosed as having other diseases. Only 4 patients (13.3%) had a diagnosis of endometriosis based on endoscopic biopsy findings. The most common misdiagnosis was submucosal tumor in the large intestine (n = 8, 26.7%), followed by malignancies of the colon/rectum (n = 3, 10.0%) and ovary (n = 3, 10.0%).
Symptoms of intestinal endometriosis mimic various intestinal diseases, thus it is difficult to diagnose preoperatively. Intestinal endometriosis should be considered when women of reproductive age have ambiguous symptoms and signs with preoperative evaluations.
It will be meaningful to study about more long term results of patients with intestinal endometriosis and their potency of malignant formation.