Rectal Endometriosis Causing Colonic Obstruction and Concurrent Endometriosis of the Appendix

From Journal of Medical Case Reports
Rectal Endometriosis Causing Colonic Obstruction and Concurrent Endometriosis of the Appendix
A Case Report
N Katsikogiannis; AK Tsaroucha; K Dimakis; E Sivridis; CE Simopoulos

Authors and Disclosures

Posted: 09/14/2011; J Med Case Reports. 2011;5(3) © 2011 BioMed Central, Ltd.

Click link below to read more
http://www.medscape.com/viewarticle/748886

Abstract and Introduction


Abstract

Introduction: Endometriosis is a clinical entity which presents with functioning endometrial tissue at sites outside the uterus. Bowel endometriosis is usually asymptomatic, but it may show non-specific symptoms. The presence and/or association of appendiceal endometriosis, concomitant with rectal endometriosis, is possible.

Case presentation: A 36-year-old Greek woman was admitted to the emergency room of our hospital with signs of acute abdomen. On physical examination, our patient had a painful distended abdomen. Digital examination revealed an empty rectum and bowel obstruction was diagnosed. Our patient underwent exploratory laparotomy and rectum stenosis (almost complete obstruction) was observed. The bowel stenosis was resected, and temporary colostomy and appendectomy were performed. The pathology report showed endometriosis of the colon and the appendix, and our patient received medical treatment for endometriosis. Six months after this operation our patient had another surgery for restoration of large bowel continuity. No endometriosis was found. Our patient was doing well at the one-year follow up.

Conclusion: Endometriosis of the bowel is a disease that may cause large bowel obstruction. In women of reproductive age, the surgeon should consider endometriosis as a differential diagnosis in case of various gastrointestinal symptoms.

Introduction

Endometriosis is a clinical entity, which was first described by von Rokitansky Kitansky as the presence of functioning endometrial tissue at sites outside the uterus.[1,2] Endometriosis occurs in 3–10% of the general female population of reproductive age, 40–80% present symptoms such as pelvic pain, infertility, or both.[2,3] Endometriosis rarely involves the small intestine, the appendix, the colon, the lung or other tissues.[4,5]

Bowel endometriosis is usually asymptomatic, but it may show non-specific symptoms, such as abdominal colic-like pain, nausea, vomiting, and general symptoms of intestinal obstruction.[6,7] Circumferential endometriosis of the rectum should be differentially diagnosed from inflammatory or malignant diseases.[5] Endometriosis of the appendix usually presents with abdominal pain.[8] The presence and/or association of appendiceal endometriosis, concomitant with rectal endometriosis, is possible, because endometriosis could occur in more than one anatomical location at the same time.

A PubMed search revealed less than 20 reported cases of large bowel obstruction due to endometriosis in the last 10 years. In none of these reports was the appendix involved. We add here an additional case report. We present a case of rectal endometriosis and bowel obstruction, together with appendiceal endometriosis, diagnosed after surgical treatment in a female patient of reproductive age.


Section 1 of 5

Endometriosis can Reach Your Bowel and Bladder

Endometriosis can Reach Your Bowel and Bladder


By Deborah Ross  August 31, 2011 - 2:25pm

Having endometriosis is tricky business. For many women, it’s something you have to “look forward to” every month. Sometimes friends and family don’t understand the pain you are enduring with your cycle. And sometimes endometriosis is causing abnormalities in your reproductive area, pelvis and gut that you can’t even feel.

 As defined by the American Congress of Obstetricians and Gynecologists, endometriosis occurs when the tissue that normally lines the uterus and gets shed during menstrual cycles for some reason is found growing outside the uterus, usually on the ovaries, fallopian tubes or other pelvic structures. In many cases that endometrium -- the lining -- can cause problems such as chronic abdominal pain, pressure or fullness in the pelvis, debilitating menstrual cramps, pain with intercourse and, sadly, infertility, according to ACOG.

Endometriosis can be an issue not only in a woman’s reproductive area, but also in the bowel and bladder. That’s because the displaced tissue responds to changes in hormones and can break down and bleed each month just as if it were in the uterus. Scar tissue, or adhesions, can form, sometimes binding organs together with painful results.

So, for many women having endometriosis, it’s not just the discomfort of a menstrual cycle but also pain that extends outward toward the digestive system. During a menstrual period, there can be diarrhea, constipation, bloating, nausea, aches in the lower back, and pain during bowel movements and urination.

More than 5 million American women have endometriosis, with it most often hitting women in their 30s and 40s, according to a fact sheet from womenshealth.gov .

The fact sheet also noted that sometimes women can have endometrial growths in a number of areas outside the uterus yet feel no pain. On the other hand, some women with endometriosis have only a few abnormal growths and still feel severe pain.

Researchers are looking at associations between endometriosis and a number of conditions, including allergies, autoimmune diseases, chronic fatigue syndrome, certain cancers and yeast infections.
Read the rest by clicking here: http://www.empowher.com/endometriosis/content/endometriosis-can-reach-your-bowel-and-bladder

New medical FICO score sparks controversy, questions

Jeremy M. Simon, On Thursday July 28, 2011, 8:00 am EDT

Within the next 12 months, whether you like it or not, about 10 million Americans are expected to be scored -- much like a credit score -- on how likely they are to fill a prescription and take all the pills the doctor ordered, on schedule.

FICO , creator of the widely used credit score that predicts whether you'll borrow responsibly, is now rolling out its new Medication Adherence Score.

FICO based its score on a formula that predicts whether you will take your prescription drugs. FICO says that since correct use of medication is important for patients, medical providers, insurers and pharmaceutical companies, the Medication Adherence Score will help achieve that goal. They predict it will improve therapy effectiveness and reduce health care costs.

The company says those who score low can be targeted for extra reminders and educational efforts, with the goal of making patients more likely to complete their prescribed regimens.

"It's very important to identify those people who may need that additional education and that additional help," says Dave Shellenberger, senior principal consultant in FICO's health care division.

Critics aren't so sure. Since the score uses information on patients' employment, homeownership and living situations, they say that in the current economic environment, the Medication Adherence Score may unfairly target people who have found themselves in challenging financial situations. It could also, they say, open the door for a new way for insurance companies to charge different prices for different scores. This happened in recent years to consumers buying auto insurance: The cost of those policies are now likely based on an auto insurance credit score .

What's in the score?
FICO launched the Medication Adherence Score on June 23, 2011. To create the scoring algorithm, FICO looked at data from a random sample of several million anonymous patients provided by a large pharmacy benefits manager. FICO observed patients who filled (or refilled) their prescriptions and patients who failed to, with the company then identifying those variables that best predicted medication adherence. For the Medication Adherence Score, those variables include age, gender, family size and asset information -- such as the likelihood of car ownership -- data also used by direct marketing companies. FICO says that with only a patient's name and address, it can pull the remainder of the necessary information from publicly available sources.

The scores range from 1 to 500. "The higher the score, the higher the likelihood a patient will be adherent to a drug regimen," FICO's Shellenberger says. FICO says patients who score 400 or higher are likely to take medication as prescribed, while those who score below 200 are at high risk of not taking medication. According to FICO, patients who earn a low score may receive a medication reminder in the form of an email, letter or phone call from their doctor -- tactics that would be too costly to apply across the board.

FICO says those who wouldn't want to receive notices should contact their health care providers and ask about their opt-out policies. High scorers who appear likely to take all their meds probably won't be contacted.

Click here to read the rest!

Rectal endometriosis causing colonic obstruction and concurrent endometriosis of the appendix: a case report

http://7thspace.com/headlines/389786/rectal_endometriosis_causing_colonic_obstruction_and_concurrent_endometriosis_of_the_appendix_a_case_report.html

Introduction Endometriosis is a clinical entity which presents with functioning endometrial tissue at sites outside the uterus. Bowel endometriosis is usually asymptomatic, but it may show non-specific symptoms.

The presence and/or association of appendiceal endometriosis, concomitant with rectal endometriosis, is possible.Case presentationA 36-year-old Greek woman was admitted to the emergency room of our hospital with signs of acute abdomen. On physical examination, our patient had a painful distended abdomen.

Digital examination revealed an empty rectum and bowel obstruction was diagnosed. Our patient underwent exploratory laparotomy and rectum stenosis (almost complete obstruction) was observed.

The bowel stenosis was resected, and temporary colostomy and appendectomy were performed. The pathology report showed endometriosis of the colon and the appendix, and our patient received medical treatment for endometriosis.

Six months after this operation our patient had another surgery for restoration of large bowel continuity. No endometriosis was found.

Our patient was doing well at the one-year follow up.

Conclusion: Endometriosis of the bowel is a disease that may cause large bowel obstruction. In women of reproductive age, the surgeon should consider endometriosis as a differential diagnosis in case of various gastrointestinal symptoms.

Author: N. KatsikogiannisA. TsarouchaK. DimakisE. SivridisC. Simopoulos

Credits/Source: Journal of Medical Case Reports 2011, 5:320

Endotimes blogger opinion: Yikes, I would never have an open surgery....if they can't do it laparoscoply then they aint good enough!