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| CASE REPORT |
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| Year : 1990 | Volume
: 36
| Issue : 2 | Page : 117-8,116B |
Ileal endometriosis (a case report).
Shah PP, Ramakantan RR, Soni MM, Desa GG
Department of Radiology, K. E. M. Hospital, Bombay, Maharashtra.
Correspondence Address:
Department of Radiology, K. E. M. Hospital, Bombay, Maharashtra.
A case of endometriosis involving small bowel is reported here. It is the first case reported at our institution in the last 10 years period.
How to cite this article:
Shah P, Ramakantan R, Soni M, Desa G. Ileal endometriosis (a case report). J Postgrad Med 1990;36:117-8,116B |
Endomtriosis is the presence of heterotopic foci of endometrium outside the uterus. Though this condition is common in the western world, it is much less frequent in India [2]. Small bowel involvement in endometriosis occurs in 8-10% of patients reported in western literature [3]. A review of the records of the departments of pathology and radiology at the K. E. M. Hospital, Mumbai over a 10 year period ending 1988, did not disclose a single case of endometriosis involving the small bowel except the case being reported here. Totally, 4% of patients undergoing laparoscopy for infertility at the KEM hospital show endometriosis.
A 28-year-old nulliparous female presented with colicky periumbilical pain for 2 years. There was no history of vomiting, haematemesis or malena. The patient had painful, irregular menstrual periods every 20-25 days lasting for 34 days. Abdominal examination was unremarkable.
A laparoscopic examination showed dense adhesions between the adnexa, the uterus and the cul-de-sac with multiple chocolate brown endometrial deposits in the lower half of the abdomen. Several loops of small bowel were seen to be adherent.
In view of adhesions seen at laparascopy, a small bowel series was performed. This (see [Figure - 1]) showed a fixed loop of ileum in the infraumbilical region. In addition, several loops of ileum were seen to be adherent in the pelvis. There was no evidence of small bowel obstruction. The patient was started on danazol.
Endometriosis is an uncommon condition in our country. About 4% of women undergoing laparoscopy at our institution have endometriosis, which is much less than the incidence of 15% reported in western literature [2]. Symptomatic involvement of the small bowel occurs in about 8% of patients with endometriosis [3]. In the light of these findings, it is surprising that small bowel involvement has not been recorded in our institution in the last 10 years, where over 1000 diagnostic laparascopies are performed each year.
Enteric lesions of endometriosis are generally serosal, usually eccentric and typically multiple. Involvement of the mucosa is uncommon. Thus, though endometrial deposits of the small bowel may lead to obstruction, bleeding is uncommon[1].
The findings on small bowel examination with barium though helpful in morphological diagnosis, are not specific. The changes include fixity of loops produced by adhesions; filling defects produced by serosal deposits and occasional changes suggestive of regional enteritis[2]. If obstruction is present, radiological examination shows its site, nature and extent.
We wish to emphasize that routine radiological examination of the small and large bowel be performed in patients with endometriosis who complain of colicky abdominal pain. As the involvement of the bowel is mainly serosal, radiological examination rather than endoscopic examination is useful in evaluating fixity and obstruction. In addition, when obstruction is present, radiological examination is mandatory to delineate its site, as operative intervention rather than conservative treatment danazol is recommended in the treatment of these patients[1].
| 1. |
Haubrich WS. Enteric endometriosis. In: "Bokus Gastroenterology" JE Berk, WS Haubrich, MH Kalser, JLA Roth, F Schaffner, editors. Philadelphia: WB Saunders Co.; 1985, pp 2484-2489.  |
| 2. | Martimbeau PW, Pratt JH, Gaffey TA. Small-bowel obstruction secondary to endometriosis. Mayo Clinic Proc 1975; 50:239-243. |
| 3. | Venable JH. Endometriosis of the ileum: Four cases with obstruction. Amer J Obstet & Gynecol 1972; 113: 1054-1055.
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