ABSTRACT
Background The bowel is the most common site of extragenital endometriosis, with involvement of the locoregional sigmoid colon and anterior rectum seen most often. The clinical presentation varies depending on how soon patients seek medical care, thus requiring changes in management strategies. Endometriosis can cause a life-threatening surgical emergency with progressive obliteration of the bowel lumen leading to obstruction and late complications including toxic megacolon and transmural necrosis. Case presentation We report the case of a 41-year-old woman presenting with an acute abdomen and complete large bowel obstruction complicated by sepsis and toxic megacolon. The patient underwent emergency total colectomy with ileostomy. Medical history was significant for chronic, vague, and episodic lower abdominal pain self-medicated with herbal tea and laxatives. Pathologic examination demonstrated colonic endometriosis within the bowel wall as the cause of obstruction, ischemia, and transmural necrosis. Conclusions Although a rare clinical entity, this case highlights two important points. First, it demonstrates the value of performing proper and complete clinical work up to rule out or in all possible causes of colonic obstruction, including intestinal endometriosis. Second, it suggests a potential benefit of a formalized multidisciplinary approach, including surgery, in the management of medically unresponsive endometriosis. In conclusion, this case shows that endometriosis can cause life-threatening colonic obstruction in women of childbearing age. Prompt early intervention is warranted, particularly when obstruction is only partial and ischemia has not supervened, to conceivably prevent the development of a toxic megacolon requiring colectomy and avoid late complications.
Subject(s)
Humans , Female , Adult , Endometriosis , Megacolon, Toxic , Colectomy , Abdomen, AcuteABSTRACT
ObjectiveTo summarize the clinical features of ulcerative eolitis (UC) complicated by toxic megacolon for early diagnosis and proper treatment. MethodsSix cases of toxic megacolon in the patients suffered from UC in Peking Union Medical College Hospital from 1983 to 2010 were analyzed,and related literature was searched and reviewed.ResultsThe incidence of the toxic megacolon in the patients with UC in our center was 0.7％ (6/824),which was lower than those reported in the literature.There were always risk factors triggering the disease.The prognosis of the patients was poor,even after medical care and surgery intervention.Evaluation of the patients and making right timing to perform the surgery would improve the prognosis of the patients in foreign literature. ConclusionIt's crucial to make early diagnosis of the toxic megacolon in the patients suffered from UC. The right choice and timing to perform urgent surgery or selective surgery may improve their prognosis.
ABSTRACT
Objective To analyze the clinical manifestations and treatment for toxic megacolon induced by drastic cathartics inpatients with an unknown history of ulcerative colitis. Methods The clinical data of 5 patients with toxic megacolon induced by ulcerative colitis with initial onset type from June 2003 to October 2008 were analyzed retrospectively. Results In 5 cases, the first symptom was abdominal pain and distention. After taking cathartics, these 5 cases were complicated with toxic megaeolon and 2 cases suffering from intestinal perforation. Four female patients suffered from transient unconsciousness, in which 3 patients were found with cerebral lacunal infarction identified by magnetic field diffusion-weighted imaging. All 5 cases underwent exploration, colectomy and ostomy, one patient died perioperatively, anastomotic fistula and anastomotic constriction developed in one each cases. Conclusions The most common clinical manifestations of toxic megacolon induced by ulcerative colitis are abdominaigia, abdominal distention. Emergency therapeutic strategy consists of partial culectomy and ostomy.