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Post a Comment Diagnosis and surgical treatment of acute intestinal obstruction caused by extragenital form of endometriosis
- Authors: Zemlyanoy Z.P.1, Sigua B.V.1, Syomin D.S.1, Gurzhiy D.V.1, Qalandarova D.H.1
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Affiliations:
- North-West State Medical University named after I.I. Mechnikov
- Issue: Vol 12, No 1 (2020)
- Pages: 97-101
- Section: Case report
- URL: https://journal-vniispk.ru/vszgmu/article/view/17922
- DOI: https://doi.org/10.17816/mechnikov202012197-101
- ID: 17922
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Abstract
Damage to the gastrointestinal tract with extragenital endometriosis is a very rare pathology. According to the literature, the frequency of damage to the gastrointestinal tract in endometriosis, after previously performed gynecological operations, is less than 1%. At the same time, involvement in the pathological process of the intestine is noted in 3–37% of women of childbearing age with diagnosed genital endometriosis. In most clinical cases extragenital endometriosis occurs intraoperatively due to the complexity of early diagnosis.
This article presents a clinical case of successful surgical treatment of a 43-year-old patient admitted to a surgical department with signs of intestinal obstruction. According to the anamnesis the patient had been suffering from recurrent pains in the lower abdomen in the right mesogastrium and constipation. The day before hospitalization, the above mentioned symptoms become worse with additional nausea, vomiting, lack of gases and feces. Based on the clinical laboratory and instrumental data the diagnosis of acute intestinal obstruction was established; and the urgent surgical treatment was carried out. Two formations were revealed intraoperatively (in the terminal ileum and in the elongated loop of the sigmoid colon). Both formations circularly narrowed the intestinal lumen, however the ileum was the cause of obstruction. Due to the lack of histological verification and the inability to exclude the malignant nature of the formation, the surgical treatment was carried out taking into account oncological standard in the amount of ileum resection and obstructive resection of the sigmoid colon with lymphadenectomy and small intestine intubation. Pathohistological examination confirmed intestinal endometriosis. The course of the postoperative period revealed no complications. The patient was discharged on the 12th day for outpatient treatment under the supervision of a surgeon and a gynecologist at the place of residence with recommendations and subsequent planned hospitalization in order to conduct reconstructive surgery to restore intestinal patency.
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##article.viewOnOriginalSite##About the authors
Zemlyanoy V. Р. P. Zemlyanoy
North-West State Medical University named after I.I. Mechnikov
Email: vyacheslav.zemlyanoy@szgmu.ru
ORCID iD: 0000-0001-7368-5926
доктор медицинских наук, профессор, заведующий кафедрой факультетской хирургии имени И.И. Грекова
Russian Federation, Saint PetersburgB. V. Sigua
North-West State Medical University named after I.I. Mechnikov
Author for correspondence.
Email: dr.sigua@gmail.com
ORCID iD: 0000-0002-4556-4913
Head of the Center for Clinical Oncology, North-Western Medical University named after I.I. Mechnikova, deputy chief physician for oncology, professor of the department of faculty surgery named after I.I. Grekov.
Russian Federation, Saint PetersburgD. S. Syomin
North-West State Medical University named after I.I. Mechnikov
Email: cosmo@list.ru
Surgeon in the Surgical Department No. 2 of the Peter the Great Clinic
Russian Federation, Saint PetersburgD. V. Gurzhiy
North-West State Medical University named after I.I. Mechnikov
Email: Dmitrii.Gurzhii@szgmu.ru
ORCID iD: 0000-0002-4005-0403
Candidate of Medical Sciences, Head of the Surgical Department No. 2 of the Peter the Great Clinic
Russian Federation, Saint PetersburgD. H. Qalandarova
North-West State Medical University named after I.I. Mechnikov
Email: diyorakalandarova931@gmail.com
ORCID iD: 0000-0002-8497-8553
Clinical Resident of the Department of Faculty Surgery. I.I. Grekova
Russian Federation, Saint PetersburgReferences
- Адамян Л.В., Андреева Е.Н., Аполихина И.А., и др. Эндометриоз: диагностика, лечение и реабилитация. Федеральные клинические рекомендации по ведению больных. − М., 2013. [Adamyan LV, Andreeva EN, Apolikhina IA, et al. Endometrioz: diagnostika, lechenie i reabilitatsiya. Federal’nye klinicheskie rekomendatsii po vedeniyu bol’nykh. Moscow; 2013. (In Russ.)]
- Шлык Д.Д., Киценко Ю.Е., Маркарьян Д.Р., и др. Сравнение методов диагностики и лечения эндометриоидных очагов атипичного расположения // Архив акушерства и гинекологии им. В.Ф. Снегирева. − 2018. − Т. 5. − № 3. − С. 157−163. [Shlyk DD, Kitsenko YE, Markar’yan DR, et al. Comparison of diagnostic methods and treatment of endometriosis of atypical location. Arkhiv akusherstva i ginekologii im. V.F. Snegireva. 2018;5(3):157-163. (In Russ.)]. https://doi.org/10.18821/2313-8726-2018-5-3-157-163.
- Падруль М.М., Олина А.А., Садыкова Г.К. Клиническое наблюдение больной с эндометриозом кишечника // Акушерство и гинекология. − 2017. − № 2. − С. 125−129. [Padrul’ MM, Olina AA, Sadykova GK. Clinical observation of a patient with bowel endometriosis. Akush Ginekol (Mosk). 2017;(2):125-129. (In Russ.)]. https://doi.org/10.18565/aig.2017.2.125-9.
- Галлямов Э.А., Аминова Л.Н., Насырова Н.И., и др. Глубокий инфильтративный эндометриоз с поражением толстого кишечника. Выбор оптимальной хирургической тактики // Таврический медико-биологический вестник. − 2017. − Т. 20. − № 2-2. − С. 17−23. [Gallyamov EA, Aminova LN, Nasyrova NI, et al. Glubokiy infil’trativnyy endometrioz s porazheniem tolstogo kishechnika. Vybor optimal’noy khirurgicheskoy taktiki. Tavricheskiy mediko-biologicheskiy vestnik. 2017;20(2-2):17-23. (In Russ.)]
- Imasogie DE, Agbonrofo PI, Momoh MI, et al. Intestinal obstruction secondary to cecal endometriosis. Niger J Clin Pract. 2018;21(8):1081-1085. https://doi.org/10.4103/njcp.njcp_29_18.
- Blau JN, Gaugas JM. Parathymic lymph nodes in rats and mice. Immunology. 1968;14(5):763-765. 1409411.
- Мельников М.В., Чупрынин В.Д., Аскольская С.В. Вопросы клинической диагностики эндометриоза кишечника // Акушерство и гинекология. − 2013. − № 5. − C. 48−53. [Mel’nikov MV, Chuprynin VD, Askol’skaya SV. Issues in the clinical diagnosis of bowel endometriosis. Akush Ginekol (Mosk). 2013;(5):48-53. (In Russ.)]
- Arafat S, Alsabek MB, Almousa F, Kubtan MA. Rare manifestation of endometriosis causing complete recto-sigmoid obstruction: A case report. Int J Surg Case Rep. 2016;26:30-33. https://doi.org/10.1016/j.ijscr.2016.07.004.
- Jayant M, Kaushik R, Punia RS. Endometriotic stricture of the sigmoid colon presenting with intestinal obstruction. S Afr J Surg. 2014;52(1):26-28.
- Alatise OI, Sabageh D, Ogunniyi SO, Olaofe OO. Ileal endometriosis presenting as acute small intestinal obstruction: a case report. West Afr J Med. 2010;29(5):352-355.
- Schnieber D, Wagner-Kolb D. [Malignant transformation of extragenital endometriosis]. Geburtshilfe Frauenheilkd. 1986;46(9):658-659. https://doi.org/10.1055/ s-2008-1036277.
- Machairiotis N, Stylianaki A, Dryllis G, et al. Extrapelvic endometriosis: a rare entity or an under diagnosed condition? Diagn Pathol. 2013;8:194. https://doi.org/ 10.1186/1746-1596-8-194.
- Глушков Н.И., Пахмутова Ю.А., Бельский И.И., и др. Диагностическое значение абдоминальной гипертензии при лечении больных с острой кишечной непроходимостью // Вестник Северо-Западного государственного медицинского университета им. И.И. Мечникова. − 2018. − Т. 10. − № 1. − C. 33−36. [Glushkov NI, Pakhmutova YA, Bel’skiy II, et al. The role of abdominal hypertension in optimizing the treatment of patients with acute intestinal obstruction. Vestnik Severo-Zapadnogo gosudarstvennogo meditsinskogo universiteta im. I.I. Mechnikova. 2018;10(1):33-36. (In Russ.)]. https://doi.org/10.17816/mechnikov201810133-36.
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