Abstract
Acute intestinal obstruction is one of the few gastrointestinal symptomatology that intestinal endometriosis frequently manifests as in the reproductive age group of females. The majority of diagnosis is still laparoscopy or laparotomy with removal of affected areas for biopsy. Endometriosis affects up to 15% of menstrual women. In 3%-37% of women, endometriosis causes gastrointestinal involvement in the sigmoid colon, rectum, and terminal ileum. Proliferation and infiltration of the intestinal wall with endometriotic tissue may result in a fibrotic response with the development of strictures and adhesions, most likely as a result of the cyclical hormonal impact of menstruation. This can eventually lead to acute to recurrent abdominal pain and bowel obstruction. When it comes to identifying endometriosis, magnetic resonance imaging offers a good sensitivity (77- 93%). On immunohistochemistry (IHC) the stromal and epithelial cells are estrogen receptor (ER) positive and the stromal cells positive for CD10. This also helps in ruling out other differentials like crohn’s disease especially involving ileum with fistulae formation, acute appendicitis with phlegmon formation and in rare instance ischemic bowel disease. We hereby present a case of a 41-year-old nulliparous female with past history of ectopic pregnancy (aborted) with small bowel endometriosis who experienced severe colicky diffuse abdominal pain. Her imaging study revealed that she had multiple edematous dilated bowel loops with no peristalsis. She was hemodynamically unstable and underwent an emergency exploratory laparotomy, which revealed gangrenous jejunal loops and histopathology confirmed gangrenous small bowel with endometriosis. Post operative period was uneventful and smooth and she is on regular follow-up.
Published Version
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