子宮內膜異位引起之迴腸出血

Lower Gastrointestinal Tract Bleeding Caused by Ovarian Endometriosis Invading the Ileum

一位50歲女子罹患無疼痛性下消化道出血，緊急大腸鏡檢查只發現全部大腸充滿鮮血而無法發現出血處，經腹部探查始發現迴腸處有一囊狀腫瘤沾黏並引發出血。此腫瘤乃一卵巢子宮內膜異位瘤，因侵犯小腸漿膜層並引起小腸黏膜破裂而出血。此患者患有慢性C型肝炎合併肝硬化，術後3週死於傷口感染及肝衰竭。根據文獻記載，雖然迴盲腸處之子宮內膜異位瘤有時會引起腹痛或腸阻塞，其大多不引起症狀。根據此一病例報告，我們建議特別在女子發生不明原因消化道出血時，子宮內膜異位須列入鑑別診斷。

A 50-year-old woman suffered from painless lower gastrointestinal tract bleeding. Emergent colonoscopy disclosed fresh-blood coating throughout the whole course up to cecum, while no active bleeding site was found. At laparotomy, one active bleeder in the ileum with one cystic tumor adhesive to it was found. The tumor was histopathologically an ovarian endometrioma invading the serosa of the ileum, and it resulted in intestinal mucosal tearing to bleed. The patient, a victim of liver cirrhosis associated with chronic hepatitis C, finally died of wound infection and liver failure 3 weeks after operation. According to the literature, most cases of ileocecal endometriosis are asymptomatic, although some might experience abdominal pain and/or intestinal obstruction. With this case report, we suggest that an ovarian endometriosis invading the intestine should be included in the differential diagnosis of lower gastrointestinal tract bleeding, especially when the exact cause of bleeding remains unknown in a female patient.