Attieh Philippe, Irani Emilio, Raheb Joy, Raheb Roy, Karam Karam, Fiani Elias
Department of Internal Medicine, University of Balamand, Beirut, Lebanon.
Department of Gastroenterology and Hepatology, University of Balamand, Beirut, Lebanon.
Eur J Case Rep Intern Med. 2025 May 20;12(6):005472. doi: 10.12890/2025_005472. eCollection 2025.
Endometriosis is a chronic inflammatory condition affecting 5-10% of women of reproductive age, most commonly involving pelvic organs. Gastrointestinal endometriosis, particularly at the terminal ileum, is rare and can clinically mimic other conditions such as Crohn's disease, posing significant diagnostic challenges. We report the case of a 45-year-old woman with no prior medical or gynecologic history who presented with a 1-week history of nausea, vomiting, abdominal pain, and obstipation. Imaging studies revealed terminal ileal lesions, and colonoscopy identified a large obstructive polypoid lesion 4 cm proximal to the ileocecal valve. She underwent laparoscopic ileocolic resection, which revealed an obstructed and perforated terminal ileum. Histopathological analysis demonstrated florid granulation tissue, subserosal fibrosis, and a purulent exudate, with endometriotic inclusions comprising endometrial glands and stroma in the terminal ileum and appendix. The ileal and colonic mucosa were unremarkable, and no reactive lymphadenopathy was found. A final diagnosis of ileal endometriosis was made. Postoperatively, the patient recovered well, required no additional medical therapy, and experienced a significant improvement in symptoms without recurrence. This case highlights an unusual presentation of terminal ileal endometriosis causing small bowel obstruction and perforation, masquerading as Crohn's disease. The absence of typical gynecologic symptoms or mucosal abnormalities underscores the diagnostic complexity. Recognition of this rare entity is crucial, as timely surgical intervention can be curative and significantly enhance patient outcomes. This case reinforces the importance of maintaining a broad differential diagnosis in women presenting with unexplained gastrointestinal symptoms and ileal lesions.
This case underscores the rare and deceptive presentation of ileal endometriosis mimicking Crohn's disease, culminating in small bowel obstruction and perforation in a patient without any prior history or gynecologic symptoms.What sets this case apart is the presence of both ileal and appendiceal endometriotic inclusions, in the absence of typical mucosal involvement or prior diagnosis of endometriosis.The diagnosis was only confirmed postoperatively through histopathology, reinforcing the importance of considering endometriosis in the differential diagnosis of terminal ileal lesions-even in patients beyond peak reproductive years and with no classic symptoms.
子宫内膜异位症是一种慢性炎症性疾病，影响5% - 10%的育龄女性，最常累及盆腔器官。胃肠道子宫内膜异位症，尤其是在回肠末端，较为罕见，在临床上可模仿其他疾病，如克罗恩病，带来重大的诊断挑战。我们报告一例45岁女性病例，该患者既往无内科或妇科病史，出现恶心、呕吐、腹痛和便秘1周病史。影像学检查发现回肠末端病变，结肠镜检查在回盲瓣近端4厘米处发现一个大的阻塞性息肉样病变。她接受了腹腔镜回结肠切除术，术中发现回肠末端梗阻并穿孔。组织病理学分析显示有大量肉芽组织、浆膜下纤维化和脓性渗出物，在回肠末端和阑尾有包含子宫内膜腺体和间质的子宫内膜异位包涵体。回肠和结肠黏膜无异常，未发现反应性淋巴结病。最终诊断为回肠子宫内膜异位症。术后，患者恢复良好，无需额外药物治疗，症状显著改善且无复发。该病例突出了回肠末端子宫内膜异位症导致小肠梗阻和穿孔的不寻常表现，伪装成克罗恩病。缺乏典型的妇科症状或黏膜异常凸显了诊断的复杂性。认识到这种罕见疾病至关重要，因为及时的手术干预可治愈疾病并显著改善患者预后。该病例强化了对出现不明原因胃肠道症状和回肠病变的女性保持广泛鉴别诊断的重要性。
该病例强调了回肠子宫内膜异位症模仿克罗恩病的罕见且具有欺骗性的表现，最终导致一名无任何既往病史或妇科症状的患者出现小肠梗阻和穿孔。该病例的独特之处在于回肠和阑尾均存在子宫内膜异位包涵体，而无典型的黏膜受累或既往子宫内膜异位症诊断。诊断仅在术后通过组织病理学得以证实，强化了在回肠末端病变的鉴别诊断中考虑子宫内膜异位症的重要性——即使是在生育年龄高峰过后且无典型症状的患者中。
