Mussa F F, Younes Z, Tihan T, Lacy B E
Department of Surgery, Johns Hopkins Bayview Medical Center and The Johns Hopkins University School of Medicine, Baltimore, Maryland 21224, USA.
J Clin Gastroenterol. 2001 Feb;32(2):167-71. doi: 10.1097/00004836-200102000-00017.
Intestinal involvement by endometriotic tissue occurs in up to 37% of patients with endometriosis. The vast majority of patients do not experience symptoms related to the gastrointestinal tract. In particular, the complications of intestinal obstruction and malabsorption secondary to endometriosis are exceedingly uncommon. We present a 42-year-old woman with intestinal obstruction, protein-losing enteropathy, and anasarca secondary to endometriosis. She had a 1-year history of watery diarrhea, bloating, and abdominal pain with a 30-lb weight-loss over 3 months. She had no previous history of endometriosis, and laboratory investigations showed severe hypoalbuminemia, hypokalemia, and metabolic acidosis. Abdominal x-rays revealed air-fluid levels and dilated loops of small bowel. She underwent surgical resection with primary anastomosis. Pathologic evaluation showed extensive endometriosis of the small bowel and appendix, which resulted in complete obstruction. Segments of ileum also demonstrated moderate-to-marked blunting of the villi. Postoperatively, the patient had a slow recovery with resolution of anasarca and a gradual increase in her weight. This report illuminates the rare, yet significant, complications of intestinal endometriosis, including small bowel obstruction, the development of a protein-losing enteropathy, and anasarca. One should consider the possibility of intestinal endometriosis in the differential diagnosis of bowel obstruction in women of childbearing age.
子宫内膜异位组织累及肠道在高达37%的子宫内膜异位症患者中出现。绝大多数患者没有与胃肠道相关的症状。特别是，子宫内膜异位症继发的肠梗阻和吸收不良并发症极为罕见。我们报告一名42岁女性，因子宫内膜异位症继发肠梗阻、蛋白丢失性肠病和全身性水肿。她有1年水样腹泻、腹胀和腹痛病史，3个月内体重减轻30磅。她既往无子宫内膜异位症病史，实验室检查显示严重低白蛋白血症、低钾血症和代谢性酸中毒。腹部X线显示气液平面和小肠肠袢扩张。她接受了一期吻合的手术切除。病理评估显示小肠和阑尾广泛子宫内膜异位，导致完全梗阻。回肠段也显示绒毛中度至明显变钝。术后，患者恢复缓慢，全身性水肿消退，体重逐渐增加。本报告阐明了肠道子宫内膜异位症罕见但重要的并发症，包括小肠梗阻、蛋白丢失性肠病的发生和全身性水肿。在育龄女性肠梗阻的鉴别诊断中应考虑肠道子宫内膜异位症的可能性。
