In light of a case report series, researchers argue that physicians should consider the possibility that acute conditions of perforated or obstructed bowel could be caused by intestinal endometriosis.
Intestinal endometriosis usually presents as stomach pain and cramps, usually going on for some time. The appearance of the condition as an “acute abdomen,” the term clinicians use for acute states of stomach problems requiring emergency surgery, is much rarer, and an awareness among physicians about the condition may improve patients’ outcome, according to a recent study.
The study, “Acute Small Bowel Obstruction and Small Bowel Perforation as a Clinical Debut of Intestinal Endometriosis: A Report of Four Cases and Review of the Literature,” was published in the journal Internal Medicine.
Although endometriosis is a common condition, types of the disease affecting the intestines are rare. Such types of endometriosis often can be present without any obvious symptoms, or symptoms are mistakenly believed to be caused by tumors or Crohn’s disease.
Researchers at the University Hospital 12 de Octubre in Spain describes four women in which doctors did not identify the presence of intestinal endometriosis until surgery.
Three of the four patients described in the study sought hospital care after a period of nausea, vomiting, and stomach pain. One of the women had diarrhea while two others were constipated.
In two cases, examinations made doctors suspect either a tumor or complications of Crohn’s disease. In the fourth case, in which a woman had a stomach ache, doctors suspected Crohn’s disease.
All of the women underwent surgery; in two cases the surgery was acute. Two of the women had obstructed intestines, and in two, doctors found perforated organs.
In the first woman, researchers removed a 17cm long part of the small intestine, affected by a stricture and ulcers. Analysis of the tissue after surgery confirmed the damage was caused by endometriosis.
In the second woman, an obstructed part of the small intestine also was removed, confirming endometriosis after surgery. The third woman had more complex problems. The uterus had been connected to the small intestine through a fistula, and she had an abscess in the uterus.
The fourth woman had a large part of both her large and small intestines removed, which was partly perforated. Again, endometriosis was confirmed after surgery.
“We believe that considering the diagnosis of intestinal endometriosis in women in fertile age who develop nonspecific gastrointestinal symptoms will help us to prevent urgent surgeries and offer our patients the best possible outcome,” the researchers concluded.
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