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Cecal endometriosis as a cause of ileocolic intussusception.

Indraccolo U, Trevisan P, Gasparin P, Barbieri F - JSLS (2010 Jan-Mar)

Bottom Line: Endometriosis is a disease that can affect various organs, has an unclear symptomatology, and in extreme cases, can result in intestinal obstruction.This particular case illustrates the synchronous localization of endometriosis, both genital and intestinal, resulting in ileo-colic and colonic intussusception.The relative diagnostic and therapeutic approach for such a rare occurrence is discussed.

View Article: PubMed Central - PubMed

Affiliation: Operative Unit of Obstetrics and Gynecology, ULSS 17, Veneto, Italy. ugo.indraccolo@libero.it

ABSTRACT
Endometriosis is a disease that can affect various organs, has an unclear symptomatology, and in extreme cases, can result in intestinal obstruction. This particular case illustrates the synchronous localization of endometriosis, both genital and intestinal, resulting in ileo-colic and colonic intussusception. The relative diagnostic and therapeutic approach for such a rare occurrence is discussed.

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Related in: MedlinePlus

Ascending colon incised lengthwise. To the left, a large nodule of the intestinal wall at the cecum.
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Figure 2: Ascending colon incised lengthwise. To the left, a large nodule of the intestinal wall at the cecum.

Mentions: Given its intestinal location, painful symptoms, the patient's desire for pregnancy, and lack of signs of intestinal obstruction, the patient was scheduled for operative laparoscopy, also taking into consideration the possibility of carrying out extensive intestinal resection. Laparoscopy revealed a fibromatous uterus and frozen pelvis due to the presence of multiple nodules within the recto-vaginal septum, on recto-sigmoid bowel wall as well as multiple endometriotic implants on the right pelvic salpinx, pelvic peritoneum (right lateral paracolic gutter, vesicouterine excavation, and left round ligament of uterus). The patient also had extensive ileo-colic and colonic invagination (Figure 1) as far as under the hepatic flexure with distension and cyanosis of the small intestine above the invaginated section. Laparoscopic debulking of the endometriosis was thus begun by excising the endometriotic pelvic nodules, the right tube, the recto-sigma, (which required opening of the posterior vaginal fornix, where an endometriotic nodule was found), followed by right hemicolectomy (Figure 2). Histological examination confirmed the presence of intestinal endometriosis with multiple localization in the recto-sigmoid, cecum, under the ileocecal valve, and of endometriosis in all the excised tissues. Microscopic examination revealed isolated areas of endometriotic tissue in the intestinal wall of the colon that did not involve the mucosa. Postoperatively, the patient presented with fever complicated by development of recto-vaginal fistula on day 15, because fecal material was drained from the pararectal drainage and the following day was also found within the vagina. Therefore, a temporary abdominal colostomy was made through the previous minilaparotomic section. Three months after the colostomy and following healing of the recto-vaginal fistula, the patient underwent surgery for terminal reanastomosis of the recto-sigmoid and removal of the artificial anus. The patient is now in good health and reports improvement in pain symptoms.


Cecal endometriosis as a cause of ileocolic intussusception.

Indraccolo U, Trevisan P, Gasparin P, Barbieri F - JSLS (2010 Jan-Mar)

Ascending colon incised lengthwise. To the left, a large nodule of the intestinal wall at the cecum.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3021310&req=5

Figure 2: Ascending colon incised lengthwise. To the left, a large nodule of the intestinal wall at the cecum.
Mentions: Given its intestinal location, painful symptoms, the patient's desire for pregnancy, and lack of signs of intestinal obstruction, the patient was scheduled for operative laparoscopy, also taking into consideration the possibility of carrying out extensive intestinal resection. Laparoscopy revealed a fibromatous uterus and frozen pelvis due to the presence of multiple nodules within the recto-vaginal septum, on recto-sigmoid bowel wall as well as multiple endometriotic implants on the right pelvic salpinx, pelvic peritoneum (right lateral paracolic gutter, vesicouterine excavation, and left round ligament of uterus). The patient also had extensive ileo-colic and colonic invagination (Figure 1) as far as under the hepatic flexure with distension and cyanosis of the small intestine above the invaginated section. Laparoscopic debulking of the endometriosis was thus begun by excising the endometriotic pelvic nodules, the right tube, the recto-sigma, (which required opening of the posterior vaginal fornix, where an endometriotic nodule was found), followed by right hemicolectomy (Figure 2). Histological examination confirmed the presence of intestinal endometriosis with multiple localization in the recto-sigmoid, cecum, under the ileocecal valve, and of endometriosis in all the excised tissues. Microscopic examination revealed isolated areas of endometriotic tissue in the intestinal wall of the colon that did not involve the mucosa. Postoperatively, the patient presented with fever complicated by development of recto-vaginal fistula on day 15, because fecal material was drained from the pararectal drainage and the following day was also found within the vagina. Therefore, a temporary abdominal colostomy was made through the previous minilaparotomic section. Three months after the colostomy and following healing of the recto-vaginal fistula, the patient underwent surgery for terminal reanastomosis of the recto-sigmoid and removal of the artificial anus. The patient is now in good health and reports improvement in pain symptoms.

Bottom Line: Endometriosis is a disease that can affect various organs, has an unclear symptomatology, and in extreme cases, can result in intestinal obstruction.This particular case illustrates the synchronous localization of endometriosis, both genital and intestinal, resulting in ileo-colic and colonic intussusception.The relative diagnostic and therapeutic approach for such a rare occurrence is discussed.

View Article: PubMed Central - PubMed

Affiliation: Operative Unit of Obstetrics and Gynecology, ULSS 17, Veneto, Italy. ugo.indraccolo@libero.it

ABSTRACT
Endometriosis is a disease that can affect various organs, has an unclear symptomatology, and in extreme cases, can result in intestinal obstruction. This particular case illustrates the synchronous localization of endometriosis, both genital and intestinal, resulting in ileo-colic and colonic intussusception. The relative diagnostic and therapeutic approach for such a rare occurrence is discussed.

Show MeSH
Related in: MedlinePlus