Journal of Postgraduate Medicine
 Open access journal indexed with Index Medicus & ISI's SCI  
Users online: 46246  
Home | Subscribe | Feedback | Login 
About Latest Articles Back-Issues Article Submission Resources Sections Etcetera Contact
 
  NAVIGATE Here 
  Search
 
  
 RESOURCE Links
 ::  Similar in PUBMED
 ::  Search Pubmed for
 ::  Search in Google Scholar for
 ::  Article in PDF (881 KB)
 ::  Citation Manager
 ::  Access Statistics
 ::  Reader Comments
 ::  Email Alert *
 ::  Add to My List *
* Registration required (free) 

  IN THIS Article
 ::  References
 ::  Article Figures

 Article Access Statistics
    Viewed4389    
    Printed66    
    Emailed2    
    PDF Downloaded26    
    Comments [Add]    

Recommend this journal


 


 
  Table of Contents     
CASE SNIPPET
Year : 2011  |  Volume : 57  |  Issue : 2  |  Page : 135-136

Cecal endometriosis as an unusual cause of right iliac fossa pain


Department of General Surgery, Hospital of Siliana, Tunisia

Date of Web Publication4-Jun-2011

Correspondence Address:
O Baraket
Department of General Surgery, Hospital of Siliana
Tunisia
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0022-3859.81877

Rights and Permissions




How to cite this article:
Baraket O, Zribi R, Berriche A, Chokki A. Cecal endometriosis as an unusual cause of right iliac fossa pain. J Postgrad Med 2011;57:135-6

How to cite this URL:
Baraket O, Zribi R, Berriche A, Chokki A. Cecal endometriosis as an unusual cause of right iliac fossa pain. J Postgrad Med [serial online] 2011 [cited 2019 Nov 20];57:135-6. Available from: http://www.jpgmonline.com/text.asp?2011/57/2/135/81877


Endometriosis is defined as an ectopic proliferation of endometrial tissue outside the uterine cavity. [1] It is fairly common in childbearing women. Bowel involvement in endometriosis is uncommon and usually localized to the rectosigmoid and less frequently to the cecum.

A 24-year-old woman with no medical history was admitted to the hospital with a one-day history of right iliac fossa pain, nausea, and vomiting. Her menses had been irregular, with occasional dysmenorrhea. The abdominal examination revealed right lower quadrant tenderness. The white blood cell count was 10400/mm 3 . Abdominal ultrasonography was normal. A diagnosis of acute appendicitis was made clinically and the patient underwent laparoscopic exploration. The peritoneal cavity was clean. The wall of the cecum had a brown implant and plane mass, measuring 3 cm of diameter [Figure 1], [Figure 2] and [Figure 3]. No other similar implants were found. The uterus and the appendix were normal [Figure 4]. A standard right hemicolectomy was performed by laparotomy after consulting the gynecologist.
Figure 1: Endometriosis involving the interior lateral wall of the cecum

Click here to view
Figure 2: Endometriosis involving the interior lateral wall of the cecum

Click here to view
Figure 3: Endometriosis involving the interior lateral wall of the cecum

Click here to view
Figure 4: Appendicitis normal

Click here to view


The pathologic examination showed ectopic endometrial glands in the thickened muscular propria and the subserosa of the cecal wall. The mucosa was not involved. There was no microscopical evidence of acute appendicitis.

Patient's postoperative course was uneventful and she was addressed to gynecologist.

It has been estimated that 4 to 17% of all menstruating women have endometriosis; [1],[2] bowel involvement occurs in 3 to 37% of the cases, with 3.5% of cecum localization. [3]

Clinically, cecal endometriosis may mimic a number of diseases such as Crohn's disease, appendicitis, tubo-ovarian abscess. [4] Also, it can take the form of chronic or recurrent abdominal pain, or dyschezia. [3] Hence, the differential diagnosis, especially in emergency setting, is difficult. Bowel troubles are usually cyclic and associated with the period. [3],[4] Our patient presented clinically as acute appendicitis. Although, she had had irregular menses and occasional dysmenorrhea, cecal or appendiceal endometriosis was never suspected preoperatively. When she was questioned again postoperatively, she described similar pain two months ago but with no relationship between the pain, hemorrhage, and menstrual cycle and she had not had any other symptoms of endometriosis: constipation, dyschezia, etc.

As mucosal invasion by an endometrioma is quite rare, an accurate diagnosis is often difficult to make without surgery. Campacci et al.[3] reported seven cases of colorectal endometriosis with a normal mucosa at colonoscopy in all cases. At the same time, there are no radiologic or diagnostic imaging findings that are specific for endometriosis. [5] The gold standard for the definitive diagnosis of endometriosis is laparoscopy. However, because of the heterogeneous appearance of the lesions, the accuracy of laparoscopic diagnosis depends on the ability of the surgeon to recognize the disease. [4] Unequivocal diagnosis requires microscopic examination. [3] In our case, endometriosis was not suspected on the macroscopic appearance. And, right hemicolectomy was performed to avoid neglecting a malignant tumor.

Although cecal endometriosis is rare, it should be considered in female patients with right lower quadrant pain. Surgery is still the treatment of choice to avoid neglecting malignant tumor and some complications such as perforation, bowel obstruction, or bleeding.

 
 :: References Top

1.Muto MG, O'Neill MJ, Oliva E. Case records of the Massachusetts General Hospital. Case 18-2005 - a 45 year-Old woman with a painthful mass in the abdomen. N Engl J Med 2005;352:2535-42.   Back to cited text no. 1
    
2.Honoré GM. Extra pelvic endometriosis. Clin Obstet Gynecol 1999;42:699-73.  Back to cited text no. 2
    
3.Campacci R, Perretta S. Guerrieri M., Paganini AM, De Sanctis A, Ciavattini A, et al. Laparoscopic colorectal resection for endometriosis. Surg Endosc 2005;19:662-4.  Back to cited text no. 3
    
4.Varras M, Kostopanagiotou E, Katis K, Farantos Ch, Angelidou-Manika Z, Antoniou S. Endometriosis causing extensive intestinal Obstruction simulating carcinoma of the sigmoid colon: A case report and review of the literature. Euro J Gynaecol Oncol 2002;23:353-7.   Back to cited text no. 4
    
5.Bromberg SH, Waisberg J, Franco MI, Oliveira CV, Lopes RG, Godoy AC. Surgical treatment for colorectal endometriosis. Int Surg 1999;84:234-8.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

Top
Print this article  Email this article
 
Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow