Anasarca and small bowel obstruction secondary to endometriosis

Intestinal involvement by endometriotic tissue occurs in up to 37% of patie nts with endometriosis. The vast majority of patients do not experience sym ptoms related to the gastrointestinal tract. In particular, the complicatio ns of intestinal obstruction and malabsorption secondary to endometriosis a re exceedingly uncommon. We present a 42-year-old woman with intestinal obs truction, protein-losing enteropathy, and anasarca secondary to endometrios is. She had a 1-year history of watery diarrhea, bloating, and abdominal pa in with a 30-lb weight-loss over 3 months. She had no previous history of e ndometriosis- and laboratory investigations showed severe hypoalbuminemia. hypokalemia, and metabolic acidosis. Abdominal x-rays revealed air-fluid le vels and dilated loops of small bowel. She underwent surgical resection wit h primary anastomosis. Pathologic evaluation showed extensive endometriosis of the small bowel and appendix, which resulted in complete obstruction. S egments of ileum also demonstrated moderate-to-marked blunting of the villi . Postoperatively, the patient had a slow recovery with resolution of anasa rca and a gradual increase in her weight. This report illuminates the rare, yet significant, complications of intestinal endometriosis, including smal l bowel obstruction, the development of a protein-losing enteropathy, and a nasarca. One should consider the possibility of intestinal endometriosis in the differential diagnosis of bowel obstruction in women of childbearing a ge.