Peritoneal Deciduosis Presenting as Subacute Intestinal Obstruction – Case Report

Abstract

Symptomatic peritoneal deciduosis is a rare event during pregnancy and has rarely been documented in the literature. A single case of peritoneal deciduosis in pregnancy presenting as intestinal obstruction has been reported. We would like to report an additional case. INTRODUCTION Ectopic decidua (deciduosis) has been commonly described in the ovary, cervix , uterus, bowel and appendiceal serosa, omentum, renal pelvis and para-aortic and pelvic lymph nodes.1 Peritoneal deciduosis, however, is a less frequent event during pregnancy and is usually asymptomatic.2 We present an unusual case of peritoneal deciduosis in a primigravida with features of subacute intestinal obstruction. CASE REPORT A 25-year-old primigravida at 28 weeks’ gestation presented with constipation of 1 month’s duration, abdominal pain for 10 days and vomiting of 3 days’ duration. X-ray and ultrasound of the abdomen showed multiple air-fluid levels suggestive of acute intestinal obstruction. The patient was taken up for emergency laparotomy. Intraoperative findings revealed a stricturous terminal ileum. The distal ileum was resected and an ileal re-anastomosis was done. PATHOLOGICAL FINDINGS The specimen consisted of a stricturous portion of ileum received as 2 separate segments, together weighing 12g. Cut section showed an edematous mucosa with shaggy serosal surface (Fig. 1). Microscopic examination of the ileal mucosa showed focal ulceration with dense infiltration of the lamina propria by chronic inflammatory cells. The submucosa and muscular layer showed edema and congested vessels. The serosa was edematous and showed clusters of large polygonal decidual cells with abundant amphophilic cytoplasm, round-oval nucleus and prominent nucleoli surrounded by fibrous tissue (Fig. 2&3). Figure 1 Figure 1: Stricturous terminal ileum Peritoneal Deciduosis Presenting as Subacute Intestinal Obstruction – Case Report 2 of 3 Figure 2 Figure 2: Decidual cells lining serosa (HE 58: 196-199. 3. Heidegger H, Humpfner A, Hugo R, Schulz W. Peritoneal deciduosis: cause for mechanical ileus in pregnancy. Geburtshilfe Frauenheilkd 1991; 51: 307-309. Peritoneal Deciduosis Presenting as Subacute Intestinal Obstruction – Case Report 3 of 3 Author Information Mary Mathew, MD Department of Pathology, Kasturba Medical College Pankaj Bir Singh Ahluwalia, DCP Department of Pathology, Kasturba Medical College MS Susmitha, MD Department of Pathology, Kasturba Medical College Garima Goel, MD Department of Pathology, Kasturba Medical College Rajgopal Shenoy, MS Department of Surgery, Kasturba Medical College