Invagination of the terminal ileum caused by endometriosis

History and clinical findings: A 39 year old female patient presented with nausea and crampy abdominal pain in the right lower quadrant. Investigations: Physical examination showed a markley distended abdomen wit h a diffuse pain, punctum maximum in the right lower part of the abdomen an d reduced peristalsis. Plain abdominal x-rays revealed slightly dilated loo ps of small bowel with air-fluid levels. Abdominal ultrasound revealed thic kening of the bowel wall of the distal ileum and some free fluid. To exclud e Crohn's disease, Sellink-computertomography was performed, which also sho wed thickening of the wall of the terminal ileum and dilated bowel loops pr oximal to the underlying stenosis. Diagnosis, treatment and course: Intraoperatively, the terminal ileum was t hickened by scar tissue and subtotally invaginated. Histologic investigatio n of the resected specimen showed submucosal endometriosis. Conclusion: Endometriosis of the small bowel should be considered carefully in the differential diagnosis of female patients of reproductive age who s uffer from symptoms of ileus, dysmenorrhea and sterility.