A 39-year-old woman with a history of diffuse normal goiter, calcified uterine myoma, normal menstrual periods, an uneventful pregnancy and vaginal delivery, who came to the emergency room with colic abdominal pain.
The patient reported two similar episodes in the last year, which resolved spontaneously within a few hours without other accompanying symptoms.
Physical examination revealed a good general condition, with hemodynamic stability, decreased abdomen without signs, distended and tympanized mass, painful swelling in the right hemiabdomen, especially in the right peritoneal quadrant.
The laboratory tests showed discrete granulocytic leukemia and CRP levels/dl. The laboratory tests showed normal glucose, leukocyte count, liver enzymes, amylase, and amylase...
Abdominal X-rays showed dilation of the loops of the small intestine (DI), with air-fluid levels and absence of gas in the colon and rectal ampulla, uterine calcifications suggestive of myoma.
Abdominal ultrasound showed abundant gas and hyperperistalsis in the small intestine and minimal amount of free fluid between the intestinal loops.
Abdominal CT showed a marked dilatation of small intestine loops that respected terminal ileum, appreciating in preterminal ileon, ID level, change in caliber, non-dilated colon with oral opacification.
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Initially conservative treatment with nasogastric tube, fluid therapy and analgesia was applied, without evidence of clinical or radiological improvement in the following hours, so surgical intervention was decided.
The approach was performed through an infraumbilical midline laparotomy, finding a moderate amount of serous free fluid, dilation of small intestine loops and thickening of the stenosing stomach with ileocaecal adenopathy 10 cm appearance.
Pelvic examination revealed a myomatous uterus.
Ileocecal resection and mechanical side-to-side anastomosis were performed, as well as drainage of liquid from the bottom of the Douglas sac.
Samples are sent to Pathological Anatomy for histological study, reporting that at the level of terminal and blind ileum there are abundant adhesions and fibrosis in the wall.
In-depth islots and nests of endometrioid glandular epithelium and endometrial stroma were observed.
There is a focal increase in inflammatory infiltrate and fibrosis.
The intestinal wall shows hypertrophy of the muscle layers, lymph nodes without evident histological injury.
With the diagnosis of ileocecal endometriosis, and after a favorable and uncomplicated postoperative course, the patient is referred to consultation and Obstetrics to assess the beginning of treatment with evolutive hormone analogues release.
