Case report

A 38-year-old female was diagnosed with fibromyalgia and underwent a surgical myomectomy. She was admitted to hospital due to recurrent abdominal pain of over a month duration, with nausea, vomiting and diarrhea. Magnetic resonance enterography (MRE) identified a bull's eye image from the terminal ileum, due to a probable invagination from the ileum to the cecum with distended proximal loops. Colonoscopy (Fig. 1) identified an "invagination head form lesion" in the cecum with a submucosal appearance, edematous, with hematic remains, which protruded through the ileocecal valve. Ileocecectomy and right hemicolectomy was performed, which confirmed the diagnosis of ileocecal infiltrative endometriosis.

Fig. 1 Colonoscopy: "head formed lesion" of the submucosa through the ileocecal valve. 

Discussion

Endometriosis has a prevalence of 5-15% among pre-menopausal women, with a peak incidence at 27-35 years of age. Bowel affectation occurs in approximately 5-12% of cases, predominates in the rectum-sigma (75-90%) and is accompanied by pelvic pain, dysmenorrhea, dyspareunia, hypermenorrhea and hematochezia at the time of the menstrual cycles ³. Ileocecal involvement is uncommon (4-25%), with an atypical presentation of abdominal pain, nausea, vomiting and diarrhea in relation to intestinal sub-occlusive episodes. This occurred in the present case and was also reported by Guerra et al. ¹. This means that the diagnosis is not usually suspected or can be mistaken for other diseases such as irritable bowel syndrome or inflammatory bowel disease ⁴. Sometimes, it presents as an acute complication such as intestinal obstruction, as reported by Ávila et al. ².

Therefore, we recommend that all necessary procedures are carried out in all women of reproductive age with recurrent complaints of dysmenorrhea and digestive symptoms in order to rule out intestinal endometriosis.