Small bowel endometriosis masquerading as regional enteritis

A Minocha, Anil Minocha, Michael S. Davis, M S Davis, R A Wright, Richard Wright
Digestive diseases and sciences · 1994 · vol. 39(5) , pp. 1126–1133 · doi:10.1007/bf02087568 · PMID:8174427 · W2067123558
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⚙ AI-generated summary by claude@2026-06+body, 2026-06-07 ⓘ

A 35-year-old female with symptoms mimicking Crohn's disease was diagnosed with ileal endometriosis after surgical exploration revealed a stricture that failed medical management.

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This case report describes a 35-year-old menstruating woman with recurrent right lower quadrant pain, nausea, and vomiting who had small bowel obstruction on imaging, a terminal ileal stricture on barium study, and a 6-cm right lower quadrant mass on CT, leading to empiric treatment for Crohn’s disease. After failure of medical management with high-dose steroids, she underwent laparotomy, which showed ulceration and narrowing of the terminal ileum; frozen sections identified endometriosis, and ileocecectomy was performed with histopathology confirming endometriosis and no evidence of chronic inflammatory bowel disease or neoplasia. The authors note, as a key limitation, that this is a single patient experience and does not establish broader diagnostic accuracy. This paper is centrally about endometriosis — it presents small bowel endometriosis that masqueraded as regional enteritis/Crohn’s disease.

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Summary A 35-year-old female presented with recurrent right lower quadrant pain, nausea, and vomiting. She was afebrile with diffuse abdominal tenderness. Plain x-ray of abdomen revealed small bowel obstruction. A barium x-ray of the small bowel showed stricture of the terminal ileum. A CT scan of the abdomen showed a 6-cm mass in right lower quadrant. She was empirically managed as having Crohn's disease. She underwent laparotomy after failure of medical management with high-dose steroids. There was ulceration and narrowing of terminal ileum. Frozen sections revealed endometriosis. Ileocecectomy was performed. Histopathology of resected specimen confirmed the diagnosis of endometriosis, and there was no evidence of chronic inflammatory bowel disease or neoplasia. Ileal endometriosis should be considered in the differential diagnosis of Crohn's disease in menstruating females presenting with perimenstrual symptoms. Similar content being viewed by others References Cappell MS, Mandell WW, Grimes MM, Neu HC: Gastrointestinal histoplasmosis. Dig Dis Sci 33:353–360, 1988 Parr NJ, Murphy C, Holt S, Zakhour H, Crosbie R: Endometriosis and the gut. Gut 29:1112–1115, 1988 Scully RE, Mark EJ, McNeely WF, McNeely BU: Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 5-1987. N Engl J Med 316:261–268, 1987 Croom RD, Donovan ML, Schwesinger WH: Intestinal endometriosis. Am J Surg 148:660–667, 1984 Sievert W, Sellin JH, Stringer CA: Pelvic endometriosis simulating colonic malignant neoplasm. Arch Intern Med 149:935–938, 1989 Townell NK, Vanderwalt JD, Jagger GM: Intestinal endometriosis: Diagnosis and management. Br J Surg 71:629–630, 1984 Aronchick CA, Brooks FP, Dyson WL, Baron R, Thompson JJ: Ileocecal endometriosis presenting with abdominal pain and gastrointestinal bleeding. Dig Dis Sci 28:566–572, 1983 Badawy SZA, Freedman L, Numann P, Bonaventura M, Kim S: Diagnosis and management of intestinal endometriosis: A report of five cases. J Reprod Med 33:851–855, 1988 Goodman P, Raval B, Zimmerman G: Perforation of the colon due to endometriosis. Gastrointest Radiol 15:346–348, 1990 LiVolsi VA, Perzin KH: Endometriosis of the small intestine, producing intestinal obstruction or simulating neoplasm. Am J Dig Dis 19:100–108, 1974 Martimbeau PW, Pratt JH, Gaffey TA: Small-bowel obstruction secondary to endometriosis. Mayo Clin Proc 50:239–243, 1975 Keane TE, Peel ALG: Endometrioma. Dis Colon Rectum 33:963–965, 1990 Leichtling JJ: Obstruction of the small intestine caused by endometriosis. Mt Sinai J Med 39:371–376, 1972 Markham S, Carpenter SE, Rock JA: Extrapelvic endometriosis. Obstet Gynecol Clin North Am 16(1):193–219, 1989 Denton G, Schofield J, Gallagher P: Uncommon complications of laparoscopic sterilization. Ann R Coll Surg Engl 72:210–211, 1990 Bartostik D: Immunologic aspects of endometriosis. Semin Reprod Endocrinol 3:329, 1985 Mandal BK, Mani V: Colonic involvement in salmonellosis. Lancet 1:887–888, 1976 Macafee CHG, Greer HLH: Intestinal endometriosis—a report of 29 cases and a survey of literature. J Obstet Gynecol Br Commonw. 67:539–555, 1960 Melody GF: Endometriosis causing obstruction of the ileum. Obstet Gynecol 8:468–472, 1956 Rowland R, Langman J: Endometriosis of the large bowel. Pathology 21:259–265, 1989 Meyers WC, Kelvin FM, Jones RS: Diagnosis and surgical treatment of colonic endometriosis. Arch Surg 114:169–175, 1979 Henriksen E: Endometriosis. Am J Surg 90:331–337, 1955 Harty RF, Kaude JV: Invasive endometriosis of the terminal ileum: A cause of small bowel obstruction of obscure origin. South Med J 76:253–255, 1983 Nitsch B, Ho ES, Cullen J: Barium study of small bowel endometriosis. Gastrointest Radiol 13:361–363, 1988 Williams TJ, Pratt JH: Endometriosis in 1000 consecutive celiotomies: Incidence and management. Am J Obstet Gynecol 129:245–250, 1977 Afdhal NH, Smith J, Heffernan S, Doyle JS, Gaffney E: Acute small bowel obstruction secondary to endometriosis: Two case reports and a review of the literature. Irish Med J 77:141–143, 1984 Madanes AE, Farber M: Danazol. Ann Intern Med 96:625–630, 1982 Author information Authors and Affiliations Rights and permissions About this article Cite this article Minocha, A., Davis, M.S. & Wright, R.A. Small bowel endometriosis masquerading as regional enteritis. Digest Dis Sci 39, 1126–1133 (1994). https://doi.org/10.1007/BF02087568 Received: Revised: Accepted: Issue date: DOI: https://doi.org/10.1007/BF02087568

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Condition tags

mesh:D004715endometriosisbowel_endometriosis

MeSH descriptors

Crohn Disease Endometriosis Ileal Diseases Adult Crohn Disease Crohn Disease Diagnosis, Differential Endometriosis Endometriosis Female Humans Ileal Diseases Ileal Diseases Radiography

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