장을 침범한 자궁내막증에 의해 야기된 장폐색 1예
A case of intestinal obstruction caused by intestinal endometriosis
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자궁내막증은 가임기 여성에서 비교적 흔히 발생하며, 이들의 3~37%에서 장관에 발생한다고 하였다. 장침범의 호발부위는 직 장 S상결장, 충수돌기, 회장 그리고 드물게 맹장의 순으로 알려져 있다. 반면에 소장의 자궁내막증, 특히 증세를 일으키는 소장침범은 매우 드물고, 자궁내막증으로 인한 장폐색은 드문 경우로 대부분 수술 전에는 발견하기 어렵다. 장을 침범한 자궁내막증은 이전에 자궁내막증의 과거력이 있는 가임기 여성에서, 장폐색의 증세가 있는 경우 감별 진단으로 고려되어야 하며, 장폐색으로 진단된 경우에 치료는 침범한 장을 절제하는 것이다. 본 증례는 과거력상 불임 및 난소의 자궁내막종으로 두 차례 수술을 받았던 34세 여성이 오심, 구토를 동반한 하복부 통증을 주소로 내원하여 급성 장폐색 진단하에 외과에서 수술을 시행하였으며 병리학적 소견상 회장, 맹장, 충수돌기를 침범한 자궁내막증으로 진단된 경우로 이에 간단한 문헌고찰 과 함께 보고하는 바이다.
Abstract
Endometriosis is a common disease in women of reproductive age, intestinal involvement has been estimated to occur in 3% to 37% of women with endometriosis, in rectosigmoid colon, appendix, ileum and cecum, in order of decreasing frequency. On the other hand, endometriosis of the small bowel, especially symptomatic small bowel involvement, is very unusual. Endometriosis is a rare cause of intestinal obstruction, and preoperative diagnosis is very difficult. It should be considered in the differential diagnosis of women of reproductive age who present with symptoms of obstruction. The definitive treatment includes resection of the involved segment with primary anastomosis. We report a 34-year-old woman following up infertility and ovarian endometrioma. She had nausea, vomiting and low abdominal pain who was operated on acute intestinal obstruction. Pathologic finding was endometriosis involving the ileum, cecum, appendix We present the case with a brief review of literature
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