A case of ileus caused by ileal endometriosis with lymph node involvement

Endometriosis is characterized by the presence of endometrial tissue outside the uterus. However, the presence of endometriotic lesions in extrauterine locations at the terminal ileum is unusual and a preoperative diagnosis of intestinal endometriosis has proved challenging.

A 49-year-old woman visited a local hospital complaining chiefly of vomiting. Computed tomography (CT) revealed an intestinal obstruction, and she was subsequently referred to and admitted to our hospital. After insertion of an ileus tube and contrast infusion, a crab-like stenosis was observed at the end of the ileum. Although its cause was unknown, we believed this stenosis to be the source of obstruction. Another CT at our hospital showed findings of obstructive ileus with a beak sign at the proximal ileum. Laparoscopic examination was performed to investigate the cause of ileus. Since the tumor at the terminal ileum was suspected to be malignant, we converted to laparotomy and performed an ileocecal excision with lymph node dissection. Based on the intraoperative pathological examination, a diagnosis of endometriosis was suspected. Another mass was found in the rectum but we ended the operation at this point. Postoperatively, the patient was referred to a gynecologist for the management of endometriosis. She was discharged on postoperative day 9 without significant complications.

The non-specific preoperative clinical and radiological findings of ileal endometriosis make it difficult to distinguish it from other diseases. Although rare, ileal endometriosis should be considered as a differential diagnosis of intestinal obstruction in women of reproductive age.