ABSTRACT
RESUMEN La endometriosis es una enfermedad benigna definida como la implantación y proliferación extrauterinas de tejido similar al endometrio (glandular y estroma), lo que causa una respuesta inflamatoria crónica y adherencias que distorsionan la anatomía. El compromiso extragonadal es raro, pero los informes de endometriosis intestinal han aumentado de forma sustancial; los sitios afectados principalmente son el colon sigmoides y el recto; el compromiso aislado del ciego es raro y lo es aún más en una mujer posmenopáusica sin uso de terapia de reemplazo hormonal. Presentamos el caso de una mujer posmenopáusica con una obstrucción intestinal sugestiva quirúrgicamente de neoplasia del ciego, pero cuyo examen patológico reveló endometriosis.
SUMMARY Endometriosis is a benign disease defined as the extra-uterine implantation and proliferation of tissue similar to endometrium (glands and stroma), causing a chronic inflammatory response and adhesions that distort anatomy. The extra-gonadal involvement is rare, but reports of intestinal endometriosis have increased substantially, mainly affecting the sigmoid colon and rectum; isolated involvement of the cecum is rare, even more so in a postmenopausal woman without use of hormone replacement therapy. We report the case of a postmenopausal woman with intestinal obstruction surgically suggestive of malignancy; however, pathological examination revealed endometriosis.
RESUMO Endometriose no ceco de uma mulher pósmenopáusica. Reporte do caso e revisão da literatura A endometriose é uma doença benigna definida como a implantação e proliferação extrauterinas de tecido similar ao endométrio (glandular e estroma), o que causa uma resposta inflamatória crónica e aderências que distorciam a anatomia. O compromisso extragonadal es raro, mas os relatórios de endometriose intestinal há aumentado de forma substancial; os lugares afetados principalmente são o colón sigmoides e o ânus; o compromisso isolado do ceco é raro e ainda mais numa mulher pós-menopáusica sem uso de terapia de substituição hormonal. Apresentamos o caso de uma mulher pós-menopáusica com uma obstrução intestinal sugestiva cirurgicamente de neoplasia do ciego, mas cujo exame patológico revelou endometriose.
Subject(s)
Humans , Female , Middle Aged , Cecal Diseases , Postmenopause , Endometriosis , Colorectal NeoplasmsABSTRACT
Objective To investigate the value of laparoscopic diagnosis and treatment for intestinal obstruction. Methods Retrospective analysis to the clinical data of 46 cases of intestinal obstruction admitted to hospital from February 2006 to February 2009 with the application of laparoscopy. Preoperative diagnosis declared: 36 cases of adhesive intestinal obstruction, 1 case of volvulus, 3 cases of tumor, 6 eases of unconfirmed diagnosis. Results Diagnosis: 6 cases of unconfirmed diagnosis were confirmed with the help of laparoscopy. Treatment: single adhesiolysis for 32 cases of adhesive obstruction were successfully carried out under laparoscopy. 3 cases released from adhesive obstruction by cutting of the peritoneal adhesions with ultrasonic-harmonic scalpel. For 2 cases whose adhesive band lain between intestines, the separation of adhesions and the repair of intestinal wall were carried out manually from the extended puncture wound. 1 case of complex adhesion needed to conversion to laparotomy. For 2 cases of suspected intestines necrosis, the segments which are pathological deteriorated were pulled out through the extended puncture wound, cut of and created anastomosis. 2 cases of intestinal obstruction caused by sigmoid volvulus were released by the way of using instruments such as intestinal clamp to turn the obstructed intestines into normality. 1 case of necrosis of obstructed intestine caused by sigmoid volvulus was conversed to laparotomy to get rid of the necrosis part and temporary colostomy. Colonic anastomosis was carried out 3weeks later. 3 cases of obstruction caused by colon cancer undergone radical operation in the way of laparoscopic-assisted. In the follow-up of 45 cases, 3 cases recurred, which rate is 6.7%. Conclusion Application of laparoscopy to the diagnosis of intestinal obstruction is of high confirmed diagnosis rate, especially of important clinical value for some cases of unclear pathogeny. There is also an advantage for the treatment.Operation is performed in a relatively enclosed space, therefore the postoperative intestinal adhesion recurrence can be significantly reduced.