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"documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2018;151:e63" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Facts in treatment of pulmonary arterial hypertension associated with mixed connective tissue disease" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "e63" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hechos en el tratamiento de la hipertensión arterial pulmonar asociada a la enfermedad mixta del tejido conectivo" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "José Luis Callejas Rubio, Raquel Ríos Fernández, Norberto Ortego Centeno" "autores" => array:3 [ 0 => array:2 [ "nombre" => "José Luis" "apellidos" => "Callejas Rubio" ] 1 => array:2 [ "nombre" => "Raquel" "apellidos" => "Ríos Fernández" ] 2 => array:2 [ "nombre" => "Norberto" "apellidos" => "Ortego Centeno" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775318301684" "doi" => "10.1016/j.medcli.2018.02.026" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775318301684?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020618304327?idApp=UINPBA00004N" "url" => "/23870206/0000015100000011/v1_201812070631/S2387020618304327/v1_201812070631/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Ileum endometriosis and Crohn's disease" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e65" "paginaFinal" => "e66" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "António Correia-Varela-Almeida, Juan María Vázquez-Morón, Esther Ortiz-López" "autores" => array:3 [ 0 => array:4 [ "nombre" => "António" "apellidos" => "Correia-Varela-Almeida" "email" => array:1 [ 0 => "dr.acorval@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Juan María" "apellidos" => "Vázquez-Morón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Esther" "apellidos" => "Ortiz-López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Gastroenterología y Hepatología, Hospital Juan Ramón Jiménez, Huelva, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Juan Ramón Jiménez, Huelva, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Endometriosis ileal y enfermedad de Crohn" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1041 "Ancho" => 900 "Tamanyo" => 64912 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Concentric wall thickening of the terminal ileum and significant stenosis of its lumen that causes retrograde dilatation of pre-terminal ileal loops.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Endometriosis is a benign, common and chronic pathology that occurs in women of childbearing age and is characterized by the proliferation of endometrial tissue outside the uterus. The exclusive small intestine localization and its presentation as a subocclusive or obstructive condition are exceptional, which makes its diagnosis difficult because it simulates different intestinal pathologies such as Crohn's disease (CD).</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 38-year-old woman with a few-months history of abdominal pain, diarrhoea, vomiting and weight loss. She came to the emergency room complaining of pain in the right iliac fossa and no bowel movements in the last few days. A distended abdomen and tympany were observed on examination. Lab tests showed no leukocytosis and acute phase reactants were normal. A plain X-ray of the abdomen showed dilatation of the loops with presence of air-fluid levels. The abdominal CT showed a concentric wall thickening in a 4<span class="elsevierStyleHsp" style=""></span>cm segment of the terminal ileum with stenosis of its lumen that causes retrograde loop dilatation. We identified at least 3 additional short segments of ileum with wall thickening and submucosal oedema that caused lumen stenosis interspersed with dilated small intestine loops, these findings being suggestive of CD-type inflammatory bowel disease (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Treatment with steroids was initiated and the patient was admitted to the hospital ward with partial improvement of symptoms, showing fluid and semisolid food tolerance. A magnetic resonance enterography was performed, a segment of 5<span class="elsevierStyleHsp" style=""></span>cm was observed in the terminal ileum, with circumferential wall thickening that caused lumen obliteration with significant and extensive dilatation of the preterminal ileum. Locoregional vascular engorgement, local mesenteric fat oedema or locoregional lymphadenopathies were not observed.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">A colonoscopy was also performed, showing nodular mucosa occupying half the circumference in the terminal ileum, proving hard to sampling. There was evident terminal ileum involvement, although not typical of inflammatory bowel disease. Histological results gave evidence of oedema, inflammation, ulceration and granulation tissue formation.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Coinciding with the onset of menstruation, a new episode of intestinal occlusion reappeared with poor progression, so an exploratory laparotomy was decided. A tumour was observed in the stenosing ileocecal valve with patchy whitish invaginating lesions, performing an ileocecal resection with good progression after the intervention. The resection specimen had foci of endometriosis, reaching the definitive histological diagnosis of intestinal endometriosis.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Endometriosis is a disease that can occur in up to 15% of childbearing age women.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> Intestinal involvement ranges between 3 and 37%. The most frequent location is rectosigmoid (85–95%) and the small intestine is the least affected, between 5% and 7% of cases.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> It is clinically characterized by abdominal and/or pelvic pain that occurs or is exacerbated with menstruation. In addition, diarrhoea, vomiting and abdominal distension may appear, nonspecific symptoms similar to other gastrointestinal disorders. Intestinal obstruction presentation is rare (7–23%), occurring mainly in the ileum.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> The diagnosis requires a detailed medical record, physical examination and imaging techniques (endovaginal or endorectal ultrasound, CT and/or MRI) and, occasionally, exploratory laparoscopy.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Colonoscopy will rarely show mucosal involvement. The established diagnosis is histopathological. The treatment depends on the form of presentation and the gestational desire of the patient. Intestinal resection is indicated if there are obstructive symptoms, bleeding or if neoplastic pathology has not been ruled out.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> Resection of the involved intestinal segment followed by hormonal treatment usually shows good results in patients of childbearing age.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Given that, in many cases, intestinal endometriosis is not suspected preoperatively, it is important to know how to differentiate it from CD and include it in the differential diagnosis of right iliac fossa pain.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> In our case, continuous normal acute phase reactants levels, absence of clear signs of activity in the MRI enterography and the findings of the colonoscopy made the diagnosis of CD doubtful.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Thus, we should suspect ileal endometriosis when faced with a young patient diagnosed with CD whose presentation is atypical or has a torpid course, with failure of the usual treatment and especially if the symptoms recur in a cyclical fashion.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Correia-Varela-Almeida A, Vázquez-Morón JM, Ortiz-López E. Endometriosis ileal y enfermedad de Crohn. Med Clin (Barc). 2018;151:e65–e66.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1041 "Ancho" => 900 "Tamanyo" => 64912 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Concentric wall thickening of the terminal ileum and significant stenosis of its lumen that causes retrograde dilatation of pre-terminal ileal loops.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anisakiasis and intestinal endometriosis: under-recognized conditions in the differential diagnosis of acute abdomen" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. 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Albarracín-Marín-Blázquez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.17235/reed.2016.4292/2016" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Enferm Dig" "fecha" => "2016" "volumen" => "108" "paginaInicial" => "524" "paginaFinal" => "525" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27022815" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endometriosis como causa de invaginación intestinal" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.S. Santamaria" 1 => "A.S. Gualberto" 2 => "M.R.A. Díaz" 3 => "R.C. Cerquera" 4 => "E.P. Llave" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Clin Esp" "fecha" => "2007" "volumen" => "207" "paginaInicial" => "533" "paginaFinal" => "537" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17988606" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endometriosis intestinal como causa de abdomen agudo" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Juárez" 1 => "M.A. Durán" 2 => "A.M. Rivera" 3 => "S.E. Téllez" 4 => "R. Buitrón" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Invest Gin Obst" "fecha" => "2013" "volumen" => "40" "paginaInicial" => "134" "paginaFinal" => "135" "itemHostRev" => array:3 [ "pii" => "S0959804916324789" "estado" => "S300" "issn" => "09598049" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015100000011/v1_201812070631/S2387020618304339/v1_201812070631/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015100000011/v1_201812070631/S2387020618304339/v1_201812070631/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020618304339?idApp=UINPBA00004N" ]
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Vol. 151. Issue 11.
Pages e65-e66 (December 2018)
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Vol. 151. Issue 11.
Pages e65-e66 (December 2018)
Letter to the Editor
Ileum endometriosis and Crohn's disease
Endometriosis ileal y enfermedad de Crohn
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