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Small bowel endometriosis masquerading as regional enteritis
A Minocha1, M S Davis, R A Wright
1Department of Medicine, University of Louisville School of Medicine, Kentucky.
Digestive Diseases and Sciences
|May 1, 1994
Summary
Ileal endometriosis can mimic Crohn's disease in women experiencing lower abdominal pain. Surgical removal confirmed endometriosis, ruling out inflammatory bowel disease or cancer.
Area of Science:
- Gastroenterology
- Gynecology
- Surgical Pathology
Background:
- Crohn's disease and endometriosis are common conditions affecting women of reproductive age.
- Both conditions can present with similar symptoms, including abdominal pain, nausea, and vomiting, often localized to the right lower quadrant.
- Diagnostic challenges arise when symptoms overlap, necessitating a thorough differential diagnosis.
Observation:
- A 35-year-old female presented with recurrent right lower quadrant pain, nausea, and vomiting, initially managed as suspected Crohn's disease.
- Imaging revealed small bowel obstruction and a terminal ileum stricture, with a 6-cm mass noted on CT scan.
- Laparotomy demonstrated ulceration and narrowing of the terminal ileum, with frozen sections indicating endometriosis.
Findings:
- Histopathology confirmed endometriosis as the cause of the ileal stricture and mass.
- The resected specimen showed no evidence of chronic inflammatory bowel disease (Crohn's disease) or neoplasia.
- This case highlights a rare presentation of endometriosis mimicking a common gastrointestinal disorder.
Implications:
- Ileal endometriosis should be included in the differential diagnosis for menstruating females with symptoms suggestive of Crohn's disease, particularly with perimenstrual exacerbation.
- Accurate diagnosis is crucial for appropriate management, differentiating between inflammatory, neoplastic, and ectopic endometrial conditions.
- This case underscores the importance of considering gynecological pathology in unexplained gastrointestinal symptoms in women.