Ileal perforation due to ileocecal endometriosis: a case with an unusual clinical and pathological presentation

A 34-year-old woman, was admitted to the emergency room of our hospital with a history of symptoms of abdominal pain dating back several years and transitorily related to the menstrual cycle. These had worsened in the days prior to admission. Radiological and clinical examinations detected no signs of peritonitis. During exploratory operative laparoscopy, opted for because of persistence and intensification of the abdominal pain, diffuse peritonitis was found due to an ileal perforation immediately upstream of an ileocaecal mass causing a precaecal stenosis. Laparoscopy enabled us to diagnose the preoperatively undetected complication, to perform a through peritoneal lavage and, following minimal conversion by laparotomy, to perform ileocaecal resection, thereby limiting the severity of the surgical trauma. The definitive pathological diagnosis was ileocaecal endometriosis with signs of transmural fistulisation and the presence of endometrial glandular structures in one of the lymph nodes around the lesion. Perforation is a rare complication on those segments of the intestine most often affected by endometriosis, such as the colon and appendix. However, it is even more unusual when it affects the ileum and no other cases have been reported in the literature. Its genesis is attributed to late diagnosis. The pathological findings highlight the particular characteristics of this case. We would stress the pre-, intra- and postoperative diagnostic difficulties encountered and the importance of a thorough anamnestic assessment when making differential diagnoses in women of child-bearing age with abdominal or pelvic pain and perimenstrual symptoms.