Findings of Endometriosis by Capsule Endoscopy

Purpose: A 17 year old female was seen in consultation for multiple episodes of intermittent small bowel obstruction. Methods: Each time the patient improved with conservative management. Upper and lower endoscopies were non diagnostic. A small bowel follow through x-ray was reported as normal. There was no evidence of inflammatory bowel disease. The patient then underwent a capsule endoscopy. The capsule study revealed a mass lesion in the distal ileum. The overlying mucosa appeard normal. Some of the images suggest a central depression. There was no ulceration or bleeding. The capsule was retained at the site for approximately 45 minutes and then spontaneously passed. The patient was subsequently referred for exploratory laparotomy. She underwent a partial ileal resection to remove the mass. Histopathology revealed small bowel endometriosis. Results: Endometriosis is a relatively common condition characterized by implantation and proliferation of endometrial glands outside the uterus affecting 8% to 15% of women. Intestinal involvement is relatively common. It is reported in 12% to 37% of individuals with the disease. Of these cases, only 7% involve the small bowel. Most small bowel cases involve the distal ileum. Conclusion: To our knowledge there are no reports of finding of endometriosis by capsule endoscopy. Search was made on PubMed and the capsuleendoscopy.org atlas websites. Our case represents an advance case where the lesion appeared as a mass leading to intermittent small bowel obstruction. Since small bowel endometriosis is relatively rare, more subtle findings will be documented as more cases are diagnosed. We suspect that many cases of ileal endometriosis may not yield any luminal findings by capsule endoscopy. One must have a high index of suspicion in the subgroup of patients that this disorder afflicts. A normal small bowel capsule endoscopy does not rule out endometriosis of the small bowel. We don't belive that possible small bowel endometriosis is an indication to perform capsule endoscopy. History of small bowel obstruction should not preculde capsule endoscopy. Many times it may lead to a definitive diagnosis.Figure: Ileal mass-endometriosis.