Multiple lesions of endometriosis in the small intestine treated by the shaving technique: A case report

Abstract

A case is reported of endometriosis present in several areas of the small intestine, successfully treated by excision using the conservative technique of shaving the intestinal wall. A 30-year-old woman with a 10-year history of pelvic pains, menstrual cramps since menarche, dyspareunia, and infertility for 3 years presented with symptoms of abdominal distension, diarrhea, nausea, and vomiting during menstruation, previously diagnosed as irritable bowel syndrome and dysbiosis. The diagnosis of deep endometriosis was made by clinical history, specialized physical examination, magnetic resonance imaging, and ultrasound mapping with intestinal preparation. The extensive pelvic endometriosis and a complex intestinal lesion in the rectosigmoid indicated the need for surgical intervention. During surgery, seven lesions of endometriosis were identified in the terminal ileum, as well as lesions in the uterine parametrium, ectocervical region, rectosigmoid, bilateral endometriomas, appendix, right iliac fossa and right diaphragmatic dome, which were not visualized in the preoperative examination. The excision included en bloc peritonectomy, segmental resection of the rectum, and removal of the intestinal lesions using a shaving technique and reinforcement sutures. There were no postoperative complications. Histopathological examination confirmed endometriosis. Endometriosis of the small intestine is a challenge to diagnose before surgery due to the lack of standardized imaging tests. Diagnostic suspicion should be based on symptoms of abdominal distension, nausea, or vomiting during menstruation. The shaving technique allowed for the safe removal of multiple lesions from the small intestine, proving a practical and reproducible approach.