[Stenosis of the terminal ileum. Endometriosis as the differential diagnosis of Crohn's disease]

J Körber, Körber J, Grammel S, S Grammel, H Lobeck, Lobeck H, Weidemann H, H Weidemann
Deutsche medizinische Wochenschrift (1946) · 1997 · doi:10.1055/s-2008-1047710 · PMID:9280705
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This paper presents a case where endometriosis mimicking Crohn's disease caused stenosis in the terminal ileum, highlighting endometriosis as a differential diagnosis for such findings.

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This case report describes a 25-year-old woman presenting with chronic abdominal pain, diarrhea, and weight loss who was initially diagnosed with Crohn's disease due to a stenosis in the terminal ileum. Surgical resection revealed that the fibrotic stricture was actually caused by numerous islands of endometriosis located in the subserosa and muscularis propria, rather than inflammatory bowel disease. The authors conclude that while rare, intestinal endometriosis can mimic Crohn's disease and should be considered as a differential diagnosis for young women with similar gastrointestinal symptoms. This paper is centrally about endometriosis — specifically its presentation as an extra-pelvic cause of terminal ileum stenosis mimicking Crohn's disease.

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Abstract

HISTORY AND CLINICAL FINDINGS: A 25-year-old woman had for 5 years complained of lower and mid-abdominal pain, at first monthly but later continuous and gradually increasing in severity. At the same time she had diarrhoea associated with nausea, vomiting and weight loss. Physical examination showed a markedly distended abdomen, diffuse pain on pressure over the whole abdomen, most marked in the left middle and lower part, and high pitched peristalsis, but was otherwise unremarkable. INVESTIGATIONS: Abdominal radiography indicated small-intestinal ileus, while ultrasound revealed absent peristalsis in the small intestine and a 10 cm stenosis in the terminal ileum. Coloscopy demonstrated a fibrosed stenosis of the terminal ileum but a biopsy showed no specific changes. TREATMENT AND COURSE: Under suspicion of Crohn's disease with stenosis of the terminal ileum a partial resection of the ileum was performed. The ileum was on inspection thickened with scar tissue but no inflammation. Histology revealed florid chronic mucosal and submucosal inflammation, haemorrhages and ulcers, as well as numerous islands of endometriosis in the subserosa and muscularis propria. CONCLUSION: Endometriosis is a rare disease in women of the reproductive age, but should be considered in the differential diagnosis of Crohn's disease of the terminal ileum.
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Abstract

History and clinical findings: A 25-year-old woman had for 5 years complained of lower and mid-abdominal pain, at first monthly but later continuous and gradually increasing in severity. At the same time she had diarrhoea associated with nausea, vomiting and weight loss. Physical examination showed a markedly distended abdomen, diffuse pain on pressure over the whole abdomen, most marked in the left middle and lower part, and high pitched peristasis, but was otherwise unremarkable. Investigations: Abdominal radiography indicated small-intestinal ileus, while ultrasound revealed absent peristalsis in the small intestine and a 10 cm stenosis in the terminal ileum. Coloscopy demonstrated a fibrosed stenosis of the terminal ileum but a biopsy showed no specific changes. Treatment and course: Under suspicion of Crohn's disease with stenosis of the terminal ileum a partial resection of the ileum was performed. The ileum was on inspection thickened with scar tissue but no inflammation. Histology revealed florid chronic mucosal and submucosal inflammation, haemorrhages and ulcers, as well as numerous islands of endometriosis in the subserosa and muscularis propria.

Conclusion

Endometriosis is a rare disease in women of the reproductive age, but should be considered in the differential diagnosis of Crohn's disease of the terminal ileum.

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Condition tags

endometriosis

MeSH descriptors

Crohn Disease Endometriosis Ileal Diseases Adult Biopsy Chronic Disease Colonoscopy Constriction, Pathologic Constriction, Pathologic Constriction, Pathologic Constriction, Pathologic Crohn Disease Crohn Disease Crohn Disease Diagnosis, Differential Endometriosis Endometriosis Endometriosis Female Humans

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europepmc
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pubmed
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