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Gastrointestinal Imaging |
1 From the Departments of Radiology (V.J.S., M.S.L., H.H., M.W.), Pathology and Laboratory Medicine (E.E.F.), and Obstetrics and Gynecology (R.W.T.), Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104. Received March 5, 1999; revision requested May 28; revision received June 14; accepted June 20. Address reprint requests to M.S.L. (e-mail: levine@oasis.rad.upenn.edu).
PURPOSE: To determine the radiographic findings in five patients with ileal endometriosis.
MATERIALS AND METHODS: A search of radiology files revealed five patients with 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; age 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 menstruation. Barium studies revealed endometriotic implants in the terminal ileum 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 lesions with spiculated folds and abrupt or tapered borders in two, and a plaquelike lesion in one. In four patients who underwent double-contrast barium enema studies, associated endometriotic implants were found in the rectosigmoid colon.
CONCLUSION: Ileal endometriosis usually involves the terminal ileum within 10 cm of the ileocecal valve and manifests as a spectrum of findings on barium studies. Ileal endometriosis should therefore be considered when these findings are present in young, nulliparous women with abdominal or pelvic pain.
Index terms: Endometriosis, 742.318 • Ileum, 742.1271, 742.318 • Intestines, radiography, 742.1271
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