SciELO - Scientific Electronic Library Online

vol.110 número3Diagnóstico morfológico y funcional de una rara entidad: pseudohipertrofia lipomatosa del páncreasUna complicación rara tras la realización de una colonoscopia: la lesión esplénica índice de autoresíndice de materiabúsqueda de artículos
Home Pagelista alfabética de revistas  

Servicios Personalizados




Links relacionados

  • En proceso de indezaciónCitado por Google
  • No hay articulos similaresSimilares en SciELO
  • En proceso de indezaciónSimilares en Google


Revista Española de Enfermedades Digestivas

versión impresa ISSN 1130-0108

Rev. esp. enferm. dig. vol.110 no.3 Madrid mar. 2018 


Bowel obstruction secondary to deep infiltrating endometriosis of the ileum

Marco-Antonio Ávila-Vergara1  2  , Violeta Sánchez-Carrillo3  , Felipe Peraza-Garay4 

1Departamento de Ginecología. Hospital General Regional nº 1. Instituto Mexicano del Seguro Social. Culiacán, Sinaloa. México

2Facultad de Medicina. Universidad Autónoma de Sinaloa. Culiacán, Sinaloa. México

3Departamento de Ginecología y Obstetricia. Coordinación Universitaria del Hospital Civil de Culiacán. Universidad Autónoma de Sinaloa. Culiacán, Sinaloa. México

4Centro de Investigación y Docencia en Ciencias de la Salud. Universidad Autónoma de Sinaloa. Culiacán, Sinaloa. México

Key words:  Deep infiltrating endometriosis; Inflammatory bowel syndrome; Ileal obstruction; Ileum

Dear Editor,

Deep infiltrating endometriosis (DIE) of the ileum is an uncommon lesion that may have a severe clinical presentation. Diagnosis is challenging in the absence of a gynecological history of endometriosis and due to the anatomical location 1. We read the article by Sánchez, Candel, and Albarracín 2 and would like to report an additional case that was managed urgently.

Case report

The case was a 41-year-old female who presented to the Emergency Room (ER) due to acute abdominal pain. She had a history of irritable bowel syndrome. On admission, the patient was conscious, well oriented, with mild mucosal dehydration. The vital signs were normal and there were no respiratory complications. She had abdominal tenderness on deep palpation and the abdomen was distended with tympanites and increased peristalsis. The pelvic ultrasound was normal. Small-bowel loops and the stomach were dilated, with a reduced caliber area at the terminal ileum. An emergency exploratory laparotomy (ELAP) was performed, which revealed lax interloop adhesions and an ileal growth of 2.5 cm in diameter that occluded 90% of the intestinal lumen at 6 cm from the ileocecal valve. A segmental resection of the terminal ileum, cecal appendix and ascending colon, with a partial omentectomy and side-to-side ileotransversal anastomosis, was performed. The outcome was uneventful. The histopathology analysis identified deep infiltrating endometriosis of the ileum (Fig. 1). The tumor markers were as follows: CA125 of 212 and CAE of 3 ng/ml. A single subcutaneous dose of goserelin acetate at 10.8 mg was prescribed. After two months, the CA125 levels were 22.

Fig. 1 Microscopic image. A. The intestinal mucosa is shown. The muscular layer includes tissue clusters comprised of linear glands, some tortuous and some overtly dilated. Some hemosiderophages are seen (old bleeding). Since the glands are imbedded in a loose stroma, this is identified as endometrial tissue. B. Endometrial cell cluster within the muscular layer. Glands (straight, tortuous, dilated) are imbedded in a loosely cellular stroma. 


The diagnostic difficulty associated with ileal DIE has been extensively reported 3) (4. Most patients experience mild symptoms in the long-term, although intestinal complications may occur. Furthermore, endoscopic findings may mimic other inflammatory bowel conditions. In cases with no mucosal involvement, the differential diagnosis should include carcinoma and inflammatory bowel disease 5.

In contrast with the series reported by Sánchez et al., no endometriosis lesions were found in the peritoneum.


1. Fedele L, Berlanda N, Corsi C, et al. Ileocecal endometriosis: Clinical and pathogenetic implications of an underdiagnosed condition. Fertil Steril 2014;101(3):750-3. DOI: 10.1016/j.fertnstert.2013.11.126 [ Links ]

2. Sánchez Cifuentes Á, Candel Arenas MF, Albarracín Marín-Blázquez A, et al. Intestinal endometriosis. Our experience. Rev Esp Enferm Dig 2016;108(8):524-5. DOI: 10.17235/reed.2016.4292/2016 [ Links ]

3. Seaman H, Ballard K, Wright J, et al. Endometriosis and its coexistence with irritable bowel syndrome and pelvic inflammatory disease: Findings from a national case - Control study. Part 2. BJOG 2008;115:1392-6. DOI: 10.1111/j.1471-0528.2008.01879.x [ Links ]

4. De Cicco C, Corona R, Schonman R, et al. Bowel resection for deep endometriosis: A systematic review. BJOG 2011;118:285-91. DOI: 10.1111/j.1471-0528.2010.02744.x [ Links ]

5. Jiang W, Roma AA, Lai K, et al. Endometriosis involving the mucosa of the intestinal tract: A clinicopathologic study of 15 cases. Modern Pathology 2013;26:1270-8. DOI: 10.1038/modpathol.2013.51 [ Links ]