Endo the line: stricturing terminal ileum endometriosis

Tushar Agrawal, Richard Maguire, Sooraj Pillai, Arun Naik
In: International Surgery Journal · 2024 · vol. 11(3) , pp. 453–456 · doi:10.18203/2349-2902.isj20240576 · W4392297379
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⚙ AI-generated summary by claude@2026-06, 2026-06-13 ⓘ

This case study describes a 38-year-old female whose terminal ileum stricture, initially mimicking Crohn's disease, was ultimately diagnosed as endometriosis through surgical resection and histology.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 · read from full text ⓘ

This paper describes a 38-year-old woman with recurrent mechanical small bowel obstruction and a terminal ileum transition point, initially evaluated as Crohn’s disease based on prior anal fissure, elevated fecal calprotectin, and imaging consistent with terminal ileitis with stricture, despite no tissue confirmation from colonoscopy. The patient underwent laparoscopic ileocolic resection, and histology showed an endometrial stricture with secondary mucosal inflammation, with no established features of Crohn’s disease. The key finding is that terminal ileum stricturing endometriosis can closely mimic Crohn’s ileitis, creating a diagnostic trap when tissue confirmation is lacking. Relevance to endometriosis: the case centers on endometriosis presenting as a terminal ileum stricture that mimicked Crohn’s ileitis, underscoring small-bowel diagnostic enigma in endometriosis.

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Abstract

Endometriosis is the implantation and proliferation of endometrial tissue outside the uterus, and while involvement of the small bowel is rare, it is particularly unusual for it to present with terminal ileum stricture mimicking Crohn’s ileitis. We present the case of a 38-year-old female with recurrent mechanical small bowel obstruction with transition point in the terminal ileum. She was struggling with infertility issues and was not previously known to have endometriosis. The presumptive diagnosis was Crohn’s disease due history of previous anal fissure, high faecal calprotectin level, and imaging findings of terminal ileitis with stricture, despite lacking tissue confirmation from colonoscopy. She underwent laparoscopic ileocolic resection with histology showing endometrial stricture and secondary mucosal inflammation, without any established features of Crohn’s disease. This case demonstrates the potential diversity in presentation of endometriosis, including small bowel manifestations that can mimic Crohn’s ileitis. If endometrioma can be confidently diagnosed based on characteristic imaging features or tissue sample, unnecessary treatment may be avoided, whilst appropriate specialist management improves endometriosis symptoms and fertility outcomes.
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Endo the line: stricturing terminal ileum endometriosis DOI: https://doi.org/10.18203/2349-2902.isj20240576Keywords: Crohn's ileitis, Endometriosis, Small bowel obstruction, StrictureAbstract Endometriosis is the implantation and proliferation of endometrial tissue outside the uterus, and while involvement of the small bowel is rare, it is particularly unusual for it to present with terminal ileum stricture mimicking Crohn’s ileitis. We present the case of a 38-year-old female with recurrent mechanical small bowel obstruction with transition point in the terminal ileum. She was struggling with infertility issues and was not previously known to have endometriosis. The presumptive diagnosis was Crohn’s disease due history of previous anal fissure, high faecal calprotectin level, and imaging findings of terminal ileitis with stricture, despite lacking tissue confirmation from colonoscopy. She underwent laparoscopic ileocolic resection with histology showing endometrial stricture and secondary mucosal inflammation, without any established features of Crohn’s disease. This case demonstrates the potential diversity in presentation of endometriosis, including small bowel manifestations that can mimic Crohn’s ileitis. If endometrioma can be confidently diagnosed based on characteristic imaging features or tissue sample, unnecessary treatment may be avoided, whilst appropriate specialist management improves endometriosis symptoms and fertility outcomes. Metrics References Mehmood S, Zhao S, Ain Q, Van Dellen J, Beggan C. Endometriosis of the Small Bowel: A Diagnostic Enigma. Cureus. 2021;13(6):e15520. Hickey M, Ballard K, Farquhar C. Endometriosis. BMJ. 2014;348:g1752. Seracchioli R, Poggioli G, Pierangeli F, Manuzzi L, Gualerzi B, Savelli L, et al. Surgical outcome and long-term follow up after laparoscopic rectosigmoid resection in women with deep infiltrating endometriosis. BJOG. 2007;114(7):889-95. Pereira RM, Zanatta A, Preti CD, de Paula FJ, da Motta EL, Serafini PC. Should the gynecologist perform laparoscopic bowel resection to treat endometriosis? Results over 7 years in 168 patients. J Minim Invasive Gynecol. 2009;16(4):472-9. McKinnon BD, Bertschi D, Bersinger NA, Mueller MD. Inflammation and nerve fiber interaction in endometriotic pain. Trends Endocrinol Metab. 2015;26(1):1-10. Giudice LC. Clinical practice. Endometriosis. N Engl J Med. 2010;362(25):2389-98. Vercellini P, Viganò P, Somigliana E, Fedele L. Endometriosis: pathogenesis and treatment. Nat Rev Endocrinol. 2014;10(5):261-75. Anglesio MS, Papadopoulos N, Ayhan A, Nazeran TM, Noë M, Horlings HM, et al. Cancer-Associated Mutations in Endometriosis without Cancer. N Engl J Med. 2017;376(19):1835-48. Agarwal SK, Chapron C, Giudice LC, Laufer MR, Leyland N, Missmer SA, et al. Clinical diagnosis of endometriosis: a call to action. Am J Obstet Gynecol. 2019;220(4):354. Bazot M, Darai E, Hourani R, Thomassin I, Cortez A, Uzan S, et al. Deep pelvic endometriosis: MR imaging for diagnosis and prediction of extension of disease. Radiology. 2004;232(2):379-89. Tran LV, Tokushige N, Berbic M, Markham R, Fraser IS. Macrophages and nerve fibres in peritoneal endometriosis. Hum Reprod. 2009;24(4):835-41. Wang G, Tokushige N, Markham R, Fraser IS. Rich innervation of deep infiltrating endometriosis. Hum Reprod. 2009;24(4):827-34. Matsuzaki S, Darcha C. Involvement of the Wnt/β-catenin signaling pathway in the cellular and molecular mechanisms of fibrosis in endometriosis. PLoS One. 2013;8(10):e76808. Burke JP, Mulsow JJ, O'Keane C, Docherty NG, Watson RW, O'Connell PR. Fibrogenesis in Crohn's disease. Am J Gastroenterol. 2007;102(2):439-48. Guglielmo FF, Anupindi SA, Fletcher JG, Al-Hawary MM, Dillman JR, Grand DJ, et al. Small Bowel Crohn Disease at CT and MR Enterography: Imaging Atlas and Glossary of Terms. Radiographics. 2020;40(2):354-75. Razzi S, Luisi S, Calonaci F, Altomare A, Bocchi C, Petraglia F. Efficacy of vaginal danazol treatment in women with recurrent deeply infiltrating endometriosis. Fertil Steril. 2007;88(4):789-94.

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