Endometriosis Can Cause Gastric Obstruction

Area of Science:

• Gastroenterology
• Gynecology
• Surgical Pathology

Background:

• Gastric outlet obstruction (GOO) is typically caused by malignancies or benign conditions like peptic ulcer disease.
• Endometriosis, a condition involving endometrial-like tissue outside the uterus, is rarely implicated in GOO.

Purpose of the Study:

• To report an unusual case of gastric outlet obstruction caused by gastric endometriosis.
• To emphasize the diagnostic challenges and considerations for this rare condition.

Main Methods:

• A case report of a 37-year-old female with a history of endometriosis and prior gynecological surgery.
• Clinical presentation, imaging (CT scan), endoscopic biopsies, and surgical resection with histopathological analysis were utilized.
• Diagnostic limitations of standard endoscopic biopsies for submucosal lesions were noted.

Main Results:

• The patient presented with severe vomiting and weight loss, initially suspected to be a gastrointestinal stromal tumor (GIST).
• Despite non-diagnostic endoscopic biopsies due to the submucosal nature of the lesion, histopathology after Whipple's resection confirmed gastric endometriosis.
• Imaging revealed a pyloric and duodenal mass with pathological lymph node enhancement.

Conclusions:

• Gastric endometriosis should be included in the differential diagnosis of gastric outlet obstruction, particularly in women with a history of endometriosis.
• Standard endoscopic biopsies may fail to diagnose submucosal gastric endometriosis.
• Advanced biopsy techniques (EUS-guided or laparoscopic) or a trial of medical therapy may be necessary before surgical intervention.