Rectal endometriosis presenting as toxic megacolon
Background: The bowel is the most common site of extragenital endometriosis, with involvement of the locoregional sigmoid colon and anterior rectum seen most often. The clinical presentation varies depending on how soon patients seek medical care, thus requiring changes in management strategies. End...
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| Format: | Article |
| Language: | English |
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University of São Paulo
2021-09-01
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| Series: | Autopsy and Case Reports |
| Subjects: | |
| Online Access: | https://www.revistas.usp.br/autopsy/article/view/190545 |
| _version_ | 1818885358374354944 |
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| author | Luis Enrique Rosario Alvarado Hisham Bahmad Odille Mejia Heather Hollembeak Robert Poppiti Lydia Howard Kiranmayi Muddasani |
| author_facet | Luis Enrique Rosario Alvarado Hisham Bahmad Odille Mejia Heather Hollembeak Robert Poppiti Lydia Howard Kiranmayi Muddasani |
| author_sort | Luis Enrique Rosario Alvarado |
| collection | DOAJ |
| description | Background: The bowel is the most common site of extragenital endometriosis, with involvement of the locoregional sigmoid colon and anterior rectum seen most often. The clinical presentation varies depending on how soon patients seek medical care, thus requiring changes in management strategies. Endometriosis can cause a life-threatening surgical emergency with progressive obliteration of the bowel lumen leading to obstruction and late complications including toxic megacolon and transmural necrosis. Case presentation: We report the case of a 41-year-old woman presenting with an acute abdomen and complete large bowel obstruction complicated by sepsis and toxic megacolon. The patient underwent emergency total colectomy with ileostomy. Medical history was significant for chronic, vague, and episodic lower abdominal pain selfmedicated with herbal tea and laxatives. Pathologic examination demonstrated colonic endometriosis within the bowel wall as the cause of obstruction, ischemia, and transmural necrosis. Conclusions: Although a rare clinical entity, this case highlights two important points. First, it demonstrates the value of performing proper and complete clinical work up to rule out or in all possible causes of colonic obstruction, including intestinal endometriosis. Second, it suggests a potential benefit of a formalized multidisciplinary approach, including surgery, in the management of medically unresponsive endometriosis. In conclusion, this case shows that endometriosis can cause life-threatening colonic obstruction in women of childbearing age. Prompt early intervention is warranted, particularly when obstruction is only partial and ischemia has not supervened, to conceivably prevent the development of a toxic megacolon requiring colectomy and avoid late complications. |
| first_indexed | 2024-12-19T16:04:10Z |
| format | Article |
| id | doaj.art-4b9cfc12fbc040a09ff7599132f19383 |
| institution | Directory Open Access Journal |
| issn | 2236-1960 |
| language | English |
| last_indexed | 2024-12-19T16:04:10Z |
| publishDate | 2021-09-01 |
| publisher | University of São Paulo |
| record_format | Article |
| series | Autopsy and Case Reports |
| spelling | doaj.art-4b9cfc12fbc040a09ff7599132f193832022-12-21T20:14:52ZengUniversity of São PauloAutopsy and Case Reports2236-19602021-09-0111Rectal endometriosis presenting as toxic megacolonLuis Enrique Rosario Alvarado0Hisham Bahmad1Odille Mejia2Heather Hollembeak3Robert Poppiti4 Lydia Howard5Kiranmayi Muddasani6 Mount Sinai Medical Center, Department of General Surgery, Miami Beach, FL, USA Mount Sinai Medical Center, The Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Miami Beach, FL, USAMount Sinai Medical Center, The Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Miami Beach, FL, USA Mount Sinai Medical Center, Department of General Surgery, Miami Beach, FL, USA Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA Mount Sinai Medical Center, The Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Miami Beach, FL, USA Mount Sinai Medical Center, Department of General Surgery, Miami Beach, FL, USABackground: The bowel is the most common site of extragenital endometriosis, with involvement of the locoregional sigmoid colon and anterior rectum seen most often. The clinical presentation varies depending on how soon patients seek medical care, thus requiring changes in management strategies. Endometriosis can cause a life-threatening surgical emergency with progressive obliteration of the bowel lumen leading to obstruction and late complications including toxic megacolon and transmural necrosis. Case presentation: We report the case of a 41-year-old woman presenting with an acute abdomen and complete large bowel obstruction complicated by sepsis and toxic megacolon. The patient underwent emergency total colectomy with ileostomy. Medical history was significant for chronic, vague, and episodic lower abdominal pain selfmedicated with herbal tea and laxatives. Pathologic examination demonstrated colonic endometriosis within the bowel wall as the cause of obstruction, ischemia, and transmural necrosis. Conclusions: Although a rare clinical entity, this case highlights two important points. First, it demonstrates the value of performing proper and complete clinical work up to rule out or in all possible causes of colonic obstruction, including intestinal endometriosis. Second, it suggests a potential benefit of a formalized multidisciplinary approach, including surgery, in the management of medically unresponsive endometriosis. In conclusion, this case shows that endometriosis can cause life-threatening colonic obstruction in women of childbearing age. Prompt early intervention is warranted, particularly when obstruction is only partial and ischemia has not supervened, to conceivably prevent the development of a toxic megacolon requiring colectomy and avoid late complications.https://www.revistas.usp.br/autopsy/article/view/190545Case ReportsMegacolonToxicEndometriosisColon |
| spellingShingle | Luis Enrique Rosario Alvarado Hisham Bahmad Odille Mejia Heather Hollembeak Robert Poppiti Lydia Howard Kiranmayi Muddasani Rectal endometriosis presenting as toxic megacolon Autopsy and Case Reports Case Reports Megacolon Toxic Endometriosis Colon |
| title | Rectal endometriosis presenting as toxic megacolon |
| title_full | Rectal endometriosis presenting as toxic megacolon |
| title_fullStr | Rectal endometriosis presenting as toxic megacolon |
| title_full_unstemmed | Rectal endometriosis presenting as toxic megacolon |
| title_short | Rectal endometriosis presenting as toxic megacolon |
| title_sort | rectal endometriosis presenting as toxic megacolon |
| topic | Case Reports Megacolon Toxic Endometriosis Colon |
| url | https://www.revistas.usp.br/autopsy/article/view/190545 |
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