[BOWEL ENDOMETRIOSIS - CASE OF RECTAL LOCALISATION.]

Endometriosis is a relatively common disease which rarely involves the bowel, and even more rarely occurs with intestinal obstruction. Gastrointestinal tract is involved in 3 to 37% of women with endometriosis such as the frequency is highest in the rectum and the sigma (72%), small intestine (7%), cecum (3.6%) and others. Our case concerns 49 years old woman with a picture of secondary intestinal obsruction, deepening during the last 2-3 months. An anterior resection of the rectum with the closure of the rectal stump has been performed with temporary colostoma - due to the severely inflamed and distended colon as a result of stenosis about 1 cm in diameter involving the portion from the Bauhin's valve to the rectal ampula, caused by two fist-sized tumors in the intestinal wall - on the rear and rear-left side of the rectum. Distally, about 2-3 cm of the tumors, on the anterior wall of the rectum have been found two plaque-like lesions, additionally. The histological result showed that the wall of the colon is engaged by transmural endometriosis, involving the mucosa, muskularis propria and serosa. The case presented differential diagnostic difficulties to exclude malignancy. The benefits of surgical treatment of intestinal endometriosis despite the significant volume of conducted surgery should not be underestimated, as with medication, it significantly improves clinical symptoms and quality of life.

Preoperative diagnosis of jejunal adenocarcinoma--a case report.

We report herein the case of a preoperatively diagnosed small bowel adenocarcinoma. A 57-year-old man was hospitalized twice for a month in the Gastroenterology Clinic due to complaints lasting a year before hospitalization and consisting of heaviness and spastic pain in the left upper abdomen. None of the numerous methods used in this case (fibrogastroduodenoscopy, ileocolonoscopy, barium series and CT) could reveal a tumor. Ultrasound (US) examination showed a polycyclic formation in the left hypochondrium with enlarged regional lymph nodes. An US-guided fine (20 gauge) needle aspiration (FNA) cytology of the mass was performed and showed moderately differentiated adenocarcinoma of intestinal origin. Thanks to Doppler US guidance during FNA a massive bleeding from an identified arterial vessel with high systolic speed was avoided. On surgical exploration a jejunal tumor of high consistency was found, located 15 cm distantly from the Treitz ligament, infiltrating up to 2/3 of the bowel circumference and partly obstructing its lumen. The histological evaluation of the resected material showed highly to moderately differentiated adenocarcinoma with 5 regional lymph node metastases. The combination of US with Doppler and FNA established preoperatively the malignant small bowel disease.

Complicated small bowel diverticulosis--a case report and literature review.

We report herein the case of a small bowel diverticulum perforation which has caused peritonitis and consequently has led to operation. The patient, a 79-year old woman, was hospitalized due to etiological clarifying and specifying of a newly diagnosed diffuse liver pathology. During the hospital stay, she has received severe abdominal pain with features of peritonitis. Suspecting perforated appendicitis she has undergone an operation. The explorative laparotomy has identified a purulent exudation in the abdominal cavity, resulting from a perforated inflammatory jejunal diverticulum and multiple middle-size diverticula all along the small bowel and the colon. The reported case as well as the review of the literature have shown that various and sometimes potentially fatal complications could occur even for such a relatively banal insignificant entity as is diverticular disease in elderly patients.