Ileal endometriosis: Radiographic findings in five cases

PURPOSE: To determine the radiographic findings in five patients with ileal endometriosis. MATERIALS AND METHODS: A search of radiology files revealed five patients w ith surgically proved endometriotic implants in the ileum at enteroclysis ( three patients), at small-bowel follow-through (one patient), and at double -contrast barium enema study (one patient). The radiographic findings were reviewed retrospectively. Clinical, surgical, and histopathologic findings were also reviewed. RESULTS: All five patients were nulliparous women (mean age, 34.4 years; ag e range, 28-41 years). Four patients presented with abdominal and/or pelvic pain, but only one of these four had cyclic pain that coincided with menst ruation. Barium studies revealed endometriotic implants in the terminal ile um within 10 cm of the ileocecal valve in four patients and in the midileum in one. The radiographic findings consisted of extrinsic mass effect with variable spiculation and tethering of folds in two patients, annular lesion s with spiculated folds and abrupt or tapered borders in two, and a plaquel ike lesion in one. In four patients who underwent double-contrast barium en ema studies, associated endometriotic implants were found in the rectosigmo id colon. CONCLUSION: Ileal endometriosis usually involves the terminal ileum within 10 cm of the ileocecal valve and manifests as a spectrum of findings on bar ium studies. Ileal endometriosis should therefore be considered when these findings are present in young, nulliparous women with abdominal or pelvic p ain.