Varras M, Kostopanagiotou E, Katis K, Farantos Ch, Angelidou-Manika Z, Antoniou S
Department of Gynaecology, George Gennimatas General State Hospital of Athens, Greece.
Eur J Gynaecol Oncol. 2002;23(4):353-7.
Endometriosis with intestinal serosal involvement is not uncommon in women of childbearing age, however, presentation as colon obstruction is rare. Lack of pathognomonic symptoms makes diagnosis difficult, the main problem being differential diagnosis with neoplasm, even intraoperatively. Reported here is a case of extensive bowel obstruction due to sigmoid colon endometriosis in a 43-year-old woman who presented with signs and symptoms of bowel obstruction. Barium enema showed sigmoid obstruction; subsequent exploratory laparotomy showed the sigmoid colon surrounded by fibrous tissue, leading to its angulation and extensive lumen obstruction. Left oophorectomy and radical resection of descending and sigmoid colon as for bowel carcinoma were successfully employed. Pathological examination revealed endometriosis in the bowel wall with preservation of the mucosa. Aetiology, clinical presentation, differential diagnosis and therapeutic options for intestinal obstruction due to endometriosis are discussed.
子宫内膜异位症累及肠浆膜在育龄女性中并不少见，然而，以结肠梗阻为表现的情况却很罕见。缺乏特异性症状使得诊断困难，主要问题在于与肿瘤进行鉴别诊断，甚至在术中也是如此。本文报道了一例43岁女性因乙状结肠子宫内膜异位症导致广泛肠梗阻的病例，该患者表现出肠梗阻的体征和症状。钡剂灌肠显示乙状结肠梗阻；随后的剖腹探查显示乙状结肠被纤维组织包围，导致其成角和广泛的管腔梗阻。成功实施了左侧卵巢切除术以及像治疗肠癌一样对降结肠和乙状结肠进行根治性切除。病理检查显示肠壁存在子宫内膜异位症，黏膜得以保留。文中讨论了子宫内膜异位症所致肠梗阻的病因、临床表现、鉴别诊断及治疗选择。
