{"paper_id":"0160f5ba-b323-47f0-8220-3a1bc2ae6a43","body_text":"Small bowel obstruction secondary to ileal endometriosis: \nmultisection computer tomography evaluation \nC. L. Fernández-Rey, S. A. Álvarez-González, P. Díaz-Solís, A. Blanco-González and S. Costilla-García \nServices of Radiodiagnosis and General Surgery. Hospital Universitario Central de Asturias. Oviedo, Asturias. Spain \n1130-0108/2009/101/12/872-874 \nREVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS \nCopyright © 2009 ARÁN EDICIONES , S. L .\nREV ESP ENFERM DIG (Madrid) \nVol. 101. N.° 12, pp. 872-874, 2009 \nApproximately 10 to 15% of pre-menopausal women are affected by endometriosis, which in rare cases can cause in -\ntestinal obstruction (1). The presence of ectopic endometriotic tissue in the loops of the small bowel affects the serosa \n(visceral peritoneum) and muscularis propria, but never penetrates the mucosa (2). Fibrosis and secondary adhesions are \nthe major causes of obstruction (2). Ileal involvement is uncommon and usually affects the terminal ileum within 10 cm of \nthe ileocecal valve (3). Intestinal endometriosis should be suspected in cases of young nulliparous women with abdominal \nor pelvic pain (3,4). \nImaging diagnosis is difficult. However, multisection \ncomputer tomography (CT) provides high spatial resolu -\ntion and multiplanar reformation images, which can be \nvery demonstrative and characteristic.\nCASE REPORT \nWe report the case of a 22-year-old woman without any \nsignificant prior medical history who presented with ab -\ndominal pain and high leukocytosis. A contrast-enhanced \nFig. 1. MIP (Maximun Intensity Projection) of a coronal contrast-enhan -\nced CT image showing the presence of two enhanced peritoneal nodu -\nles (*) and dilatation of the small bowel. \nImagen coronal MIP (maximun intensity projection) de TC con contras -\nte que demuestra la presencia de dos nódulos peritoneales hipercap -\ntantes (*) y dilatación de asas de intestino delgado. \nFig. 2. MIP from a coronal contrast-enhanced CT image showing a de -\ntailed endometriotic implant in the right ileo-cecal area (*) and a se -\ncond focus of endometriosis in the right annexial region (*). \nImagen coronal MIP de TC con contraste que muestra con detalle un \nimplante de endometriosis en el área íleo-cecal derecha (*) y un segun -\ndo foco de endometriosis en la región anexial derecha (*). \nIPD 1595 FERNANDEZ REY:Maquetación 1  28/12/09  08:18  Página 872\n\nmultisection CT was performed, which revealed significant small-bowe l dilatationand multiple nodular contrast-enhanced le-\nsions located in the pelvis (Fig. 1). One of the lesions affected the right annexialregion while the remaininglesions were locat-\ned in the visceral peritoneum involving the small bowel. The largest lesion measured approximate ly 3 cm in diameter and in-\nvolved the appendiceal region and terminal ileum, this being the transitionpoint of the obstruction(Fig. 2). The diagnosis after\nCT examination was small-bowel obstruction secondary to intestinal endometriosis.Surgery confirmed the CT findings, iden-\ntifying multiple endometriotic implants in the serosa of the small bowel, especially at the level of the terminal ileum (Figs. 3\nand 4). A segment of terminal ileum and the appendix were resected. Histopatho logical examinationof the resected specimen\nrevealed endometriotic implants involving the appendix and terminalileum.\nREFERENCES\n1. Ruiz-Tovar J, Pina Hernández JD, Lobo Martínez E, et al. Endometriosis intestinal. Rev Esp Enferm Dig 2007; 99(12): 732-3.\n2. Martimbeau PW, Pratt JH, Gaffey TA. Small-bowel obstruction secondary to endometriosis. Mayo Clin Proc 1975; 50(5): 239-43.\n3. Scarmato VJ, Levine MS, Herlinger H, Wickstrom M, Furth EE, Tureck RW. Ileal endometriosis: radiographic findings in five cases. Radiology 2000;\n214: 509-12.\n4. Woodward P J, Sohaey R, Mezzetti TP. Endometriosis: radiologic-pathologic correlation. Radiographics 2001; 21: 193-216.\nFig. 3. Image demonstrating the existence of endometriotic peritoneal\nimplants during the surgical intervention.\nImagen que demuestra la existencia de implantes de endometriosis\nperitoneales durante la intervención quirúrgica.\nFig. 4. Endometriotic implant in the visceral peritoneum, which enve-\nlops the small bowel with adhesions between loops.\nFoco de endometriosis en el peritoneo visceral que envuelve el intesti-\nno delgado con adherencias entre las asas.\nVol. 101. N.° 12, 2009 SMALL BOWEL OBSTRUCTION SECONDARY TO ILEAL ENDOMETRIOSIS: 873\nMULTISECTION COMPUTER TOMOGRAPHY EVALUATION\nREV ESP ENFERM DIG 2009; 101 (12): 872-874\nIPD 1595 FERNANDEZ REY:Maquetación 1  28/12/09  08:18  Página 873","source_license":"CC0","license_restricted":false}