A 39-year-old woman with a history of a diffuse normofunctioning goitre, calcified uterine myoma, normal menstrual periods, an uneventful pregnancy and vaginal delivery, who came to the emergency department for colicky abdominal pain together with abdominal distension and several liquid stools over 48 hours. The patient reported two similar episodes in the last year, which resolved spontaneously within a few hours, with no other accompanying symptoms. Physical examination showed good general condition, with haemodynamic stability, abdomen without scars, distended and tympanised, painful on palpation in the right hemiabdomen, especially in the right lower quadrant, with no signs of peritoneal irritation and no palpable masses or visceromegaly, decreased peristalsis. The requested blood test showed discrete leukocytosis with a predominance of granulocytes and CRP 3.7mg/dl, with the rest of the tests (glucose, ions, renal function, liver enzymes, amylase, urine system, etc.) being normal. An abdominal X-ray showed dilatation of the small intestine loops (ID), with hydro-aerial levels and absence of gas in the colon and rectal ampulla, uterine calcifications suggestive of myoma. Abdominal ultrasound showed abundant gas and hyperperistalsis in the ID and minimal free fluid between the intestinal loops. The abdominal CT scan showed marked dilatation of the loops of the ID, which respected the terminal ileum, with a change in calibre in the preterminal ileum at the level of the FID, a non-dilated colon with opacification with oral contrast, accumulation of free fluid at the level of the pouch of Douglas, and a myomatous uterus with lumpy calcifications.

Initially, conservative treatment was applied with nasogastric tube, fluid therapy and analgesia, with no clinical or radiological improvement in the following hours, so surgery was decided. The approach was performed via infraumbilical midline laparotomy, revealing a moderate amount of free serous fluid, dilation of the loops of ID and stenosing thickening in the terminal ileum, about 10 cm from the ileocaecal valve, with a tumour appearance, retraction of the serosal surface and mesenteric lymphadenopathies. Pelvic examination revealed a myomatous uterus. Ileocaecal resection and mechanical latero-lateral anastomosis were performed, as well as drainage of the fluid from the cul-de-sac of Douglas. Samples were sent to Anatomical Pathology for histological study, and it was reported that abundant adhesions and fibrosis were observed in the wall of the terminal ileum and cecum. In depth, islets and nests of endometrioid glandular epithelium and endometrial stroma were observed. Focally there is an increased inflammatory infiltrate and fibrosis. The intestinal wall shows hypertrophy of the muscle layers, lymph nodes without histologically evident lesions. With the diagnosis of ileocecal endometriosis, and after a favourable postoperative course without complications, the patient was referred to the gynaecology and obstetrics department to assess the start of treatment with gonadotropin-releasing hormone analogues and follow-up.