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Anasarca and Small Bowel Obstruction Secondary to Endometriosis

Mussa, Firas F. M.D.; Younes, Ziad M.D.; Tihan, Tarik M.D., Ph.D.; Lacy, Brian E. M.D, Ph.D.

Journal of Clinical Gastroenterology: February 2001 - Volume 32 - Issue 2 - p 167-171
Case Reports

Intestinal involvement by endometriotic tissue occurs in up to 37% of patients with endometriosis. The vast majority of patients do not experience symptoms related to the gastrointestinal tract. In particular, the complications of intestinal obstruction and malabsorption secondary to endometriosis are exceedingly uncommon. We present a 42-year-old woman with intestinal obstruction, protein-losing enteropathy, and anasarca secondary to endometriosis. She had a 1-year history of watery diarrhea, bloating, and abdominal pain with a 30-lb weight-loss over 3 months. She had no previous history of endometriosis, and laboratory investigations showed severe hypoalbuminemia, hypokalemia, and metabolic acidosis. Abdominal x-rays revealed air–fluid levels and dilated loops of small bowel. She underwent surgical resection with primary anastomosis. Pathologic evaluation showed extensive endometriosis of the small bowel and appendix, which resulted in complete obstruction. Segments of ileum also demonstrated moderate-to-marked blunting of the villi. Postoperatively, the patient had a slow recovery with resolution of anasarca and a gradual increase in her weight. This report illuminates the rare, yet significant, complications of intestinal endometriosis, including small bowel obstruction, the development of a protein-losing enteropathy, and anasarca. One should consider the possibility of intestinal endometriosis in the differential diagnosis of bowel obstruction in women of childbearing age.

From the Departments of Surgery (F.F.M.), Gastroenterology (Z.Y., B.E.L.), and Pathology (T.T.), Johns Hopkins Bayview Medical Center and The Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.

Submitted May 28, 1999.

Accepted June 21, 1999.

Address correspondence and reprint requests to Dr. Brian E. Lacy, Division of Digestive Diseases, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224, U.S.A.

© 2001 Lippincott Williams & Wilkins, Inc.