Ileocecal intussusception as the initial presentation of endometriosis: case report
A 33-year-old woman was admitted to the emergency room (ER) with abdominal pain lasting 5 days. The patient did not present comorbidities, previous abdominal surgeries or pregnancies. She reported that the abdominal pain started in the epigastrium and later migrated, localized and intensified in the right lower quadrant (RLQ). It was associated with constipation and poor flatus elimination. The symptoms were not related to menses.\nOn admission, the patient presented a pulse of 65 beats/min, blood pressure of 140/90 mm Hg, and temperature of 36.5°C. On physical examination, rebound tenderness and abdominal guarding were recognized in the RLQ, and a palpable mass was identified.\nBlood tests showed leukocytosis 12 × 109/L with 75% segmented neutrophils, C-reactive protein 8 mg/dL and hemoglobin of 14.2 g/dl. Human chorionic gonadotropin hormone beta-subunit 2.0 mUl/ml. Levels of serum CA 19–9 2.0 U/ml, and carcinoembryonic antigen 0.5 mg/ml. Metabolic panel and liver function tests were within normal limits.\nAbdominal ultrasound showed in the ascending colon, a heterogeneous mass composed of a conglomerate of intestinal loops measuring 10 × 8 × 5 cm.\nComputed tomography (CT) of the abdomen and pelvis with oral and intravenous contrast was performed (), and emergency surgery was decided due to the suspected ileocolic intussusception with a probable tumor origin (). The preoperative diagnoses were malignant cecum tumor (adenocarcinoma, sarcoma) or benign tumor (lipoma, villous tumor).\nThe initial approach was laparoscopic, recognizing a tumor in the cecum associated with ileocolic intussusception. The abdominal cavity was explored without detecting other foci of probable neoplastic origin. However, due to technical difficulties, the decision was made to convert to conventional surgery. Due to the appearance of the lesion and the suspicion of a malignant tumor, an oncological right hemicolectomy was performed with ileotransverse manual anastomosis (). The operative time was 3 hours, with an estimated blood loss of 100 cm3. It did not require red blood cell units.\nThe immediate postoperative follow-up was carried out in the intensive care unit. Later the patient went to the inpatient room, where she remained for eight days.\nThe microscopic study reported ileocolic intussusception and cecal endometriosis ( and ).\nPeriodic clinical controls were performed. Five years after surgery, the patient continues under follow-up without presenting new foci of endometriosis.