Sigmoid endometriosis and a diagnostic dilemma – A case report and literature review

H. Nasim, Nasim H, D. Sikafi, Sikafi D, Aly Nasr, Nasr A, A Nasr
International journal of surgery case reports · 2011 · vol. 2(7) , pp. 181–184 · doi:10.1016/j.ijscr.2011.06.001 · PMID:22096721 · PMC3199679 · W2159054170
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This case report highlights the diagnostic challenge of sigmoid endometriosis in a young woman, presenting with intestinal obstruction and confirmed by histopathology, emphasizing its under-recognition in differential diagnoses.

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Abstract

INTRODUCTION: Intestinal endometriosis is often an infrequently considered diagnosis in female of childbearing age by general surgeon. There is a delay in diagnosis because of constellation of symptoms and lack of specific diagnostic modalities. Patients suffer from intestinal endometriosis for many years before they are diagnosed. Often, such patients are labelled with irritable bowel syndrome. Intestinal endometriosis has a diagnostic time delay of 8-11 years due to its non-specific clinical features and multi-system involvement. PRESENTATION OF CASE: Our patient was a 32 years old Caucasian female who was referred to us with features of intestinal obstruction. Despite repeated clinical assessments and use of different diagnostic modalities the diagnosis was still inconclusive even after 21 days of her first presentation to primary care physician. She had an exploratory laparotomy, sigmoid colectomy, and Hartmann's procedure with a temporary colostomy with us. Histopathology confirmed endometriosis and also showed melanosis coli. She was referred to the gynaecological team for review and follow up. DISCUSSION: Intestinal endometriosis should be considered as a differential diagnosis in female patients of childbearing age group presenting with non-specific gastrointestinal signs and symptoms. Our patient manifested intestinal endometriosis and melanosis coli on histopathology suggesting symptoms of long duration. CONCLUSION: Bowel endometriosis is a less considered and often ignored differential diagnosis in acute and chronic abdomen. This condition has considerable effect on patient's health both physically and psychologically.

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Condition tags

endometriosisbowel_endometriosisirritable_bowel_syndrome

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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