A rare complication of  endometriosis

Endometriosis can cause ileo-colonic intussusception.

Key Points

Highlights:

• Ileocecal intussusception is a rare complication of endometriosis and must be considered in the differential diagnosis.

Importance:

• A typical pediatric condition, bowel intussusception, can occur in 5% of adults as well.

What's done here:

• This is a case report of an ileocolonic intussusception from Mexico, presented as a very rare complication of endometriosis.
• The patient is a 27 years old female with a history of one-year endometriosis.
• Symptoms were severe right lower quadrant abdominal pain-nausea-vomiting for the last 24 hours.

Points to remember:

• Ileocecal intussusception symptomology is unclear and can cause intestinal obstruction in extreme cases.
• Colonoscopy is useful to rule out other diseases such as cancer or chronic inflammatory diseases.
• Surgery should be performed immediately to prevent the ischemic potential of the condition.

Lay Summary

Morales et al. from the Monterrey School of Medicine, Mexico, reported a case of bowel intussusception in a woman with severe endometriosis to draw attention to this very rare endometriosis complication.

The case is a 27 years old young female who was followed up by a gynecologist for mild abdominal pain and endometriosis and using oral contraceptives as a first-line treatment.

She was brought to the emergency room with severe right lower abdominal pain, nausea, and vomiting, and after clinical and laboratory examinations and CT scans, a diagnostic laparoscopy was performed. With the diagnosis of ileocecal intussusception, a right hemicolectomy and ileocecal extracorporeal anastomosis were performed laparoscopically. The definitive diagnosis was ileocecal intussusception with chronic peritonitis and endometriosis.

Considering that almost all adult intussusceptions have a  malignant origin, oncologic resection with no reduction should be also performed. In this special case, due to the known endometriosis, the authors did not perform the oncologic operation. Another key point is to be quick in the surgical intervention due to the ischemic potential of the condition.

"Not to leave endometriosis foci behind, because this can result in further stenosis and higher reinvention rates", the authors recommended. In this interesting paper that was recently published in the "Clinical Journal of Gastroenterology", the authors also suggested a multidisciplinary approach for these patients for a proper follow-up. Approximately 10 earlier similar case reports were found in previous literature.

Research Source: https://pubmed.ncbi.nlm.nih.gov/34189712/