Case report

We herein present the case of a 51-year-old woman who had a simple total hysterectomy in 2009 for symptomatic uterine myomatosis. In 2016, she underwent a colonoscopy due to persistent abdominal pain. A congested and invaginated erythematous mucosa was identified that went beyond the ileocecal valve; it was not possible to delimit its extension (Fig. 1). Abdominal computed tomography (CT) showed a well-defined hypodense image of 6 x 2 cm in the cecum that acted as a head of an ileocolic intussusception that produced a subocclusion. Right hemicolectomy showed macroscopically an 8 cm fragment of invaginated mucosa in a "glove finger" form. The histology showed foci of endometriosis with adjacent ulcerated mucosa (Fig. 1). Other locations of endometriotic implants were not confirmed after follow-up by the Gynecology Service.

Fig. 1 An invaginated lesion in the caecum. Foci of endometriosis in the ileocecal region detected via histology (arrows). 

Discussion

Intestinal intussusception is a rare entity in adults (5% of cases) ² and is usually located in the small intestine as benign lesions (50-70%). When this condition involves the colon or ileocecal valve, the main cause is neoplastic such as adenocarcinoma ³. Endometriosis is an estrogen-dependent disorder that affects 12-15% of women of reproductive age ⁴ and is usually located in the recto-sigma (85-90%) ^{1) (4}. It presents a non-specific clinical manifestation including abdominal pain, dysmenorrhea, diarrhea, abdominal mass and infertility. MRI is the gold standard diagnostic technique, although an anatomopathological study is required for a definitive diagnosis ¹. It is important to bear in mind that ileocecal endometriosis can be a benign cause of intussusception in the adult.