Galazis Nicolas, Arul Dhili, Wilson Jonathan, Pisal Narendra
Whittington Hospital, London, UK.
BMJ Case Rep. 2014 Jan 10;2014:bcr2013202140. doi: 10.1136/bcr-2013-202140.
Bowel obstruction accounts for 20% of hospital admissions due to acute abdominal pain. We report a case of acute bowel obstruction in a 31-year-old woman with a history of endometriosis diagnosed on laparoscopy a year before this presentation. Her clinical and biochemical picture suggested peritonitis and CT revealed an irregular soft tissue mass compressing a dilated rectosigmoid. Pockets of intraperitoneal gas were also documented and presumed to be secondary to bowel perforation at the level of the mass. Exploratory laparotomy was performed and the affected bowel was resected. Histology revealed extensive stricturing and fibrosis secondary to intestinal endometriosis. General practitioners, gastroenterologists and general surgeons are likely to encounter endometriosis, need to be competent in its diagnosis and management and collaborate promptly with the gynaecologist. Endometriosis should be considered in the differential diagnosis of every woman of childbearing age who presents with any gastrointestinal or abdominal symptom.
肠梗阻占因急性腹痛而住院病例的20%。我们报告一例31岁女性急性肠梗阻病例,该患者一年前腹腔镜检查诊断为子宫内膜异位症。其临床和生化表现提示腹膜炎,CT显示一个不规则软组织肿块压迫扩张的直肠乙状结肠。腹腔内气体积聚也有记录,推测是肿块处肠穿孔所致。进行了剖腹探查并切除了受累肠段。组织学检查显示为肠道子宫内膜异位症继发的广泛狭窄和纤维化。全科医生、胃肠病学家和普通外科医生很可能会遇到子宫内膜异位症,需要具备诊断和管理该疾病的能力,并及时与妇科医生协作。对于每一位出现任何胃肠道或腹部症状的育龄女性,鉴别诊断时都应考虑子宫内膜异位症。