Endometrioma of the Ileocecal Valve Causing Intestinal Obstruction with Evidence of Locoregional Lymphatic Involvement

Abstract

Abstract

Background: Endometriosis is defined as the presence of tissue similar to that of the endometrial tissue although abnormally located in sites outside the uterus. The disease occurs primarily in the pelvic area, and appearance outside this area is less common. Intestinal endometriosis is a process that rarely causes intestinal obstruction; its true prevalence is unknown. Lymph-node involvement is rare. There is scant information in the literature, with most descriptions contained in case reports. Case: A 40-year-old woman presented with symptoms of intestinal obstruction secondary to endometriosis of the ileocecal valve, mimicking a tumor of the same site and involvement of 2 lymph nodes of the ileocolic chain with endometrial tissue. The patient underwent exploratory surgery and then a right hemicolectomy. Results: Following surgery, the course of this patient was favorable, and, on the sixth day following surgery, her symptoms were in remission and she was discharged to go home.Histopathologic examination showed multiple foci of the endometrial tissue primarily on the muscle layer and serous layer of the colon, and a few submucosal nodes. The lymph nodes showed reactive changes; 2 of these nodes had miscroscopic subcapsular foci of endometriosis. Conclusions: Although the physiopathology of the spread of endometriotic foci has yet to be clarified in the literature, spread through the lymph system cannot be ruled out as one of the mechanisms contributing to this long-distance dissemination. Although, in the past, exceptional cases have been described in which viable endometrial tissue has been found in the lymph nodes of affected areas, in more recent years, increasing evidence of lymph nodes involvement is being published. (J GYNECOL SURG 31:115)