STENOSIS OF THE TERMINAL ILEUM - ENDOMETR IOSIS IN THE DIFFERENTIAL-DIAGNOSIS OF CROHNS-DISEASE

History and clinical findings: A 25-year-old woman had for 5 years com plained of lower and mid-abdominal pain, at first monthly but later co ntinuous and gradually increasing in severity. At the same time she ha d diarrhoea associated with nausea, vomiting and weight loss. Physical examination showed a markedly distended abdomen, diffuse pain on pres sure over the whole abdomen, most marked in the left middle and lower part, and high pitched peristasis, but was otherwise unremarkable. Inv estigations: Abdominal radiography indicated small-intestinal ileus, w hile ultrasound revealed absent peristalsis in the small intestine and a 10 cm stenosis in the terminal ileum. Coloscopy demonstrated a fibr osed stenosis of the terminal ileum but a biopsy showed no specific ch anges. Treatment and course: Under suspicion of Crohn's disease with s tenosis of the terminal ileum a partial resection of the ileum was per formed. The ileum was on inspection thickened with scar tissue but no inflammation. Histology revealed florid chronic mucosal and submucosal inflammation, haemorrhages and ulcers, as well as numerous islands of endometriosis in the subserosa and muscularis propria. Conclusion: En dometriosis is a rare disease in women of the reproductive age, but sh ould be considered in the differential diagnosis of Crohn's disease of the terminal ileum.