It is postulated by Lin et al, that this is due to intestinal end

It is postulated by Lin et al, that this is due to intestinal endometriosis being mainly an incidental finding [4]. It is clear, that as in our case, appendicular and ileocaecal involvement is rare. In a retrospective review of 7000 patients with endometriosis the incidence of caecal and appendix involvement was 4% and 3% respectively [5]. Similarly a twelve year study assessing the anatomical distribution

of endometriosis found appendix and ileocaecal involvement in 6.4% and 4.1% of intestinal cases [6]. The aetiology of endometriosis remains unknown and controversial [2, 7]. There are many theories but currently the most widely accepted theory is that of ‘retrograde menstruation’ causing the implantation and growth of endometriosis on the serosal surface of extra-uterine organs or occurring secondary to metaplasia in the pelvic peritoneum [2, 5, 8, 9]. The concept of Selleckchem CX-6258 ‘retrograde menstruation’ is supported 4SC-202 supplier by the mainly pelvic distribution of endometriosis [6]. Although poorly understood, a combination of genetic aberrations as well as unknown environmental factors contribute to the development of endometriosis [9]. It is thought that the growth and invasion of endometrial tissue at ectopic sites is due to a process of neovacularization mediated by pro-angiogenic factors such as VEGF [10]. Small bowel endometriosis tends to only affect

the bowel serosa and deposits tend not to be greater than 2 cm in size [1, 3]. It is characterized by a patchy involvement of the bowel and macroscopically is oxyclozanide ‘grey glistening in appearance’ [3]. Although generally asymptomatic, they can lead to local inflammation resulting

in fibrosis and the formation of adhesions [1, 11].In rare circumstances the disease can be more extensive, a histological review of fifty cases of intestinal endometriosis found that only 10% of intestinal cases had mucosal involvement [3, 12]. Transmural disease damaging the mucosa can result in bleeding, the development of pseudo-tumours or obstruction secondary to ‘stenosis’ or ‘kinking’ [3, 11]. The strictures and masses arise from a reactive smooth muscle hypertrophy secondary to disease present in the muscularis propria [3]. Rare cases of small and large bowel intussception, bowel perforation and Quisinostat order malignant transformation have also been reported [11, 13, 14]. Acute bowel obstruction is a rare event occurring in less than one per cent of intestinal endometriosis and usually affects the rectosigmoid colon[1, 15, 16]. The case presented is rarely seen as small bowel obstruction only accounts for only 0.7% of all surgical interventions for endometriosis [16]. As our case serves to highlight, in an acute presentation the patient’s history is unlikely to aid the diagnosis and thus it is unlikely for patients to be diagnosed pre-operatively [1–3, 11].

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