Dor epigástrica relacionada ao período menstrual pode ser um sinal de endometriose intestinal

Sergio Podgaec, Gonçalves, Manoel Orlando, Manoel Eneas de Carvalho Gonçalves, Sidney Klajner, Maurício Simões Abrão
In: instacron:APM · 2008 · W7120413956
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A case report describes a 35-year-old woman with menstrual epigastric pain and bladder endometriosis history, who was diagnosed with ileocecal endometriosis via imaging and confirmed by histology after laparoscopic resection.

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This case report describes a 35-year-old woman with a history of bladder endometriosis who presented with recurrent epigastric pain exclusively during menstruation. Diagnostic imaging identified a lesion at the ileocecal junction and appendix, leading to laparoscopic resection and histological confirmation of bowel endometriosis. The authors conclude that cyclical upper abdominal pain in young women with endometriosis history warrants evaluation for intestinal involvement. This paper is centrally about endometriosis — specifically describing an unusual presentation of deep infiltrating endometriosis affecting the intestine and manifesting as cyclic epigastric pain.

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Abstract

CONTEXT AND OBJECTIVE: Endometriosis is a common affl iction that may affect the intestinal tract. The objective of this case report was to describe an unusual clinical presentation of this form of the disease. CASE REPORT: The patient was a 35-year-old woman with epigastric pain that only occurred during menstruation, who had a history of bladder endometriosis. Endoscopy of the upper digestive tract showed normal results. Transvaginal ultrasound and nuclear magnetic resonance of the pelvis showed a lesion involving the ileocecal junction and appendix, measuring 30 x 22 x 13 mm, that was suggestive of endometriosis. The patient underwent laparoscopic resection of the bowel segment affected by the disease, followed by anastomosis of the ileum and ascending colon for immediate restoration of intestinal transit. Histological analysis confi rmed the diagnosis of endometriosis. CONCLUSIONS: In young women, recurrent epigastric pain should be evaluated with regard to its relationship to menstruation, particularly if there is a history of endometriosis, since this may be a clinical sign that the disease is affecting the intestinal transit.
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Keywords

Endometriosis, Intestines, Laparoscopy, Diagnosis, TherapeuticsAbstract CONTEXT AND OBJECTIVE: Endometriosis is a common affl iction that may affect the intestinal tract. The objective of this case report was to describe an unusual clinical presentation of this form of the disease. CASE REPORT: The patient was a 35-year-old woman with epigastric pain that only occurred during menstruation, who had a history of bladder endometriosis. Endoscopy of the upper digestive tract showed normal results. Transvaginal ultrasound and nuclear magnetic resonance of the pelvis showed a lesion involving the ileocecal junction and appendix, measuring 30 x 22 x 13 mm, that was suggestive of endometriosis. The patient underwent laparoscopic resection of the bowel segment affected by the disease, followed by anastomosis of the ileum and ascending colon for immediate restoration of intestinal transit. Histological analysis confi rmed the diagnosis of endometriosis. CONCLUSIONS: In young women, recurrent epigastric pain should be evaluated with regard to its relationship to menstruation, particularly if there is a history of endometriosis, since this may be a clinical sign that the disease is affecting the intestinal transit. Downloads

References

Podgaec S, Abrao MS, Dias Jr JA, Rizzo LV, de Oliveira RM, Baracat EC. Endometriosis: an inflammatory disease with a Th2 immune response component. Hum Reprod. 2007;22(5):1373-9. Nisolle M, Donnez J. Peritoneal endometriosis, ovarian endo- metriosis, and adenomyotic nodules of the rectovaginal septum are three different entities. Fertil Steril. 1997;68(4):585-96. Orbuch IK, Reich H, Orbuch M, Orbuch L. Laparoscopic treatment of recurrent small bowel obstruction secondary to ileal endometriosis. J Minim Invasive Gynecol. 2007;14(1):113-5. Simoens S, Hummelshoj L, D’Hooghe T. Endometriosis: cost estimates and methodological perspective. Hum Reprod Update. 2007;13(4):395-404 Cavaliere D, Schirru A, Parodi A, et al. Successful laparoscopic treatment of ileocecal-appendicular endometriosis. J Laparoen- dosc Adv Surg Tech A. 2004;14(6):395-8. Chaer R, Sam A 2nd, Teresi M, Cintron J. Endometriosis- induced acute small and large bowel obstruction: rare clinical entities. N Z Med J. 2005;118(1217):U1521. Rovati V, Faleschini E, Vercellini P, Nervetti G, Tagliabue G, Benzi G. Endometrioma of the liver. Am J Obstet Gynecol. 1990;163(5 Pt 1):1490-2. Mangal R, Taskin O, Nezhat C, Franklin R. Laparoscopic vaporization of diaphragmatic endometriosis in a woman with epigastric pain: a case report. J Reprod Med. 1996;41(1): 64-6. Sumiyoshi Y, Yamashita Y, Maekawa T, Sakai T, Shirakusa T. A case of hemorrhagic cyst of the pancreas resembling the cystic endometriosis. Int Surg. 2000;85(1):67-70.

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