Rare presentations of small bowel endometriosis.
Anthony SakirisEzaam Naik FrazArvinf RajandranJason SmithBenjamin AllenSooraj PillaiPradeep Kakkadasam RamaswamySneha JohnPublished in: DEN open (2024)
Despite endometriosis being a relatively common chronic gynecological condition in women of childbearing age, small bowel endometriosis is rare. Presentations can vary from completely asymptomatic to reported symptoms of abdominal pain, bloating, and diarrhea. The following two cases depict very atypical manifestations of ileal endometriosis that presented as obscure intermittent gastrointestinal bleeding and bowel obstruction requiring surgical intervention. The first case describes a previously healthy 40-year-old woman with severe symptomatic iron deficiency anemia and intermittent melena. A small bowel enteroscopy diagnosed multiple ulcerated strictures in the distal small bowel as the likely culprit. Despite nonsteroidal anti-inflammatory drug-induced enteropathy being initially considered as the likely etiology, histopathological examination of the resected distal ileal segment revealed evidence of endometriosis. The second case describes a 66-year-old with a presumptive diagnosis of Crohn's disease who reported a 10-year history of intermittent perimenstrual abdominal pain, diarrhea, and nausea with vomiting. Following two subsequent episodes of acute bowel obstruction and surgical resection of the patient's stricturing terminal ileal disease, histopathological examination demonstrated active chronic inflammation with endometriosis. Small bowel endometriosis should be considered as an unusual differential diagnosis in women who may present with obscure gastrointestinal bleeding from the small bowel or recurrent bowel obstruction.
Keyphrases
- small bowel
- drug induced
- abdominal pain
- liver injury
- iron deficiency
- randomized controlled trial
- high intensity
- anti inflammatory
- oxidative stress
- lymph node
- polycystic ovary syndrome
- minimally invasive
- chronic kidney disease
- type diabetes
- metabolic syndrome
- irritable bowel syndrome
- single cell
- adipose tissue
- sleep quality
- clostridium difficile