Intestinal Endometriosis – A Case Report

Intestinal endometriosis Clinical HistoryThe woman was hospitalized four times because of abdominal pain in the right lower quadrant (RLQ), constipation, vomiting, anorexia and weight loss, with 8 months of evolution.On physical examination she presented an abdominal distension with a palpable and painful mass in the RLQ and signs of peritoneal irritation. Imaging FindingsAbdominal ultrasound (Fig. 1) demonstrated a conglomerate of distended intestinal loops in the RLQ surrounded by fluid.Several bowel loops exhibited mural thickening.After some days, abdominal and pelvic CT did not show intestinal alterations and the woman felt better after medical therapy.Suprapubic US (Fig. 2) revealed in the left ovary a cystic lesion measuring 4.7 cm in the major axis.A small effusion was visible in the cul-de sac.Colonoscopy with ileoscopy was normal, without endoluminal or mucosal lesions.CT enteroclysis (Fig. 3) showed a mass in the terminal ileum, involving the ileocecal valve and conditioning dilatation of proximal loops.An exploratory laparotomy with ileocecal resection was performed and histopathologic and immunohistochemical analyses yielded endometriosis of the ileocecal valve, cecum and appendix conditioning stenosis of the terminal ileum.