A rare case of sigmoid colon obstruction in patient with ulcerative colitis: role of transabdominal ultrasound-guided biopsy

Introduction Endometriosis is a common chronic gynaecological disease affecting 10 % of women of reproductive age. Of these 5–12 % may present bowel endometriosis that may be asymptomatic or associated with aspecific symptoms even bowel obstruction. Case presentation The case of a 41-year-old woman with history of ulcerative colitis, previous diagnosis of ovarian endometriosis, recurrent abdominal pain not related to the menstrual cycle, with abdominal pain and obstinate constipation for 2 weeks was referred. The patient underwent colonoscopy, transabdominal ultrasound and ultrasound-guided fine-needle biopsy to have a diagnosis.

Endometriosis should be considered in the differential diagnosis of every woman of childbearing age who presents with gastrointestinal or abdominal symptoms. As demonstrated in our case and by the burgeoning literature in this field, we believe that the role of transabdominal ultrasound should be reconsidered in the management of abdominal diseases because this examination associated with ultrasound-guided fine-needle biopsy allows, in expert hands, to obtain adequate histological samples avoiding patients to undergo more invasive tests to get a diagnosis. Riassunto Introduzione L’endometriosi è una malattia ginecologica cronica comune che colpisce il 10 % delle donne in età riproduttiva. Nel 5–12 % si può presentare una localizzazione intestinale della malattia. Essa può presentarsi in svariati modi potendo essere asintomatica o potendosi manifestare con sintomi aspecifici includendo perfino l’occlusione intestinale. Caso clinico presentiamo il caso di una donna di 41 anni affetta da colite ulcerosa, con storia di precedente diagnosi di endometriosi ovarica e ricorrenti dolori addominali non correlati al ciclo mestruale. Riferisce da circa due settimane il peggioramento dei dolori addominali cui si associa stipsi ostinata. È stata quindi sottoposta a colonscopia, ecografia transaddominale e biopsia ecoguidata per via transaddominale prima di poter fare una diagnosi. Discussione L’endometriosi dovrebbe essere considerata nella diagnosi differenziale in ogni donna in età fertile che si presenta con sintomi gastrointestinali o addominali vaghi. Come nel caso clinico illustrato e alla luce della fiorente letteratura in questo campo, riteniamo che il ruolo dell’ecografia transaddominale dovrebbe essere riconsiderato nella gestione delle malattie addominali. Infatti, l’ecografia transaddominale associata alla possibilità di poter eseguire in corso dello stesso esame una biopsia ecoguidata, permetterebbe di poter ottenere un adeguato campione istologico evitando al paziente esami più invasivi per raggiungere una diagnosi.

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