Veneziano M, Zaraca F, Framarino M, Di Paola M, Giobbe M, Montemurro L, Fabiani C, Filippoussis P, Mancicni B, Marzetti L, Carboni M
III Clinica Ostetrica e Ginecologica, Università degli Studi di Roma La Sapienza, Policlinico Umberto I.
Chir Ital. 1999 May-Jun;51(3):241-5.
The purpose of this study is to heighten awareness of intestinal endometriosis, a disease that may mimic other abdominal pathologies (bowel carcinoma, intestinal inflammatory disease, diverticulitis), sometimes found in the emergency setting. The Authors report a case of acute bowel obstruction due to coecal endometriosis with appendix mucocele, peritoneal pseudomyxoma and ovarian endometrioma. The patient was operated on in the emergency setting, a right colectomy was performed and she then received pharmacological suppressive treatment with Gn-RH analogues and danatrol. We remark that preoperative diagnosis is very difficult in those cases that do not have a past history of pelvic endometriosis. An accurate anamnesis regarding the chronology of pain onset (typically only during the menstruation at first), but especially intraoperative histopathologic examination are useful for diagnosis. An increased awareness of intestinal endometriosis in reproductive age women with acute bowel obstruction, associated with an accurate anamnesis of menstrual history may allow pre- or intraoperative diagnosis, which is the clue to a less aggressive operation. Postoperative follow up and hormonal therapy are mandatory.
本研究的目的是提高对肠道子宫内膜异位症的认识,这是一种可能模仿其他腹部疾病(肠癌、肠道炎症性疾病、憩室炎)的疾病,有时在急诊情况下被发现。作者报告了一例因盲肠子宫内膜异位症合并阑尾黏液囊肿、腹膜假黏液瘤和卵巢子宫内膜瘤导致的急性肠梗阻病例。该患者在急诊情况下接受了手术,进行了右半结肠切除术,随后接受了Gn-RH类似物和丹曲林的药物抑制治疗。我们指出,在那些没有盆腔子宫内膜异位症病史的病例中,术前诊断非常困难。关于疼痛发作时间顺序的准确问诊(最初通常仅在月经期间),但尤其是术中组织病理学检查对诊断很有用。提高对患有急性肠梗阻的育龄妇女肠道子宫内膜异位症的认识,并结合准确的月经史问诊,可能有助于进行术前或术中诊断,这是采取侵入性较小手术的关键。术后随访和激素治疗是必不可少的。