P0975 - At a Crossroad of Chronicity: Crohn's Disease and Endometriosis

Award: Presidential Poster Award

Kyle Pierce, DO¹, Hugo Pinillos, MD, FACG^2
1University of Arizona College of Medicine, Phoenix VA Medical Center, Phoenix, AZ; ²Carl T. Hayden Veterans' Administration Medical Center, Phoenix, AZ

Introduction: Extra-pelvic Endometriosis is a rare and chronic condition that mimics symptoms associated with inflammatory bowel disease (IBD) including abdominal pain, diarrhea and in advanced disease hematochezia. We present a case of long standing ileocolonic Crohn’s Disease (CD) who subsequently found to have extra-pelvic endometriosis after acute small bowel obstruction.

Case Description/Methods: Here we present a 44-year-old female patient with a long-standing history of ileocolonic fibrostenotic CD (Montreal A1 L3 B2), IBS-D and SIBO. Her disease course has been complicated by loss of response and side effects to numerous medications including: 5-ASA, Azathioprine, Infliximab, Adalimumab, Vedolizumab and Certolizumab pegol. Due to this, she was started on Risankizumab induction and maintenance in early 2023. On this medication she developed initial response with improve clinical symptoms and fecal calprotectin levels from 721 to 518 mcg/g. She remained stable for nearly a year before she experienced clinical signs of obstruction with post prandial pain and emesis. MR-enterography (MRE) demonstrated an interval change with luminal narrowing with upstream dilation. Due to lack of response and development of a severe stricture, she underwent laparoscopic resection of terminal ileum. Her pathology demonstrated evidence of chronic active ileitis in addition to endometrial tissue present in the serosa and the outer muscle wall of the ileum.

Discussion: Endometriosis, characterized by the presence of endometrial tissue outside the uterus, can manifest in various locations within the abdominal cavity. The bowel represents the third most common site of occurrence, following the ovaries and peritoneum. Patient with endometriosis typically present with dysmenorrhea, dyspareunia, and chronic pain, while other gastrointestinal symptoms include diarrhea, constipation, and tenesmus do occur. Consequently, patients may receive a misdiagnosis of IBS. In very rare situations, endometriosis can be responsible for abscesses, fistulae or in late-stage disease obstructive symptoms that mimic CD as in our patient. Although the pathophysiology of bowel endometriosis and CD differs markedly, previous research has consistently shown a strong link between these conditions. Endometriosis rarely involves the mucosa layers of the bowel, which precludes direct endoscopic visualization. This case demonstrates a rare co-existence of poorly controlled CD and bowel endometriosis presenting with small bowel obstructive.


Disclosures:


Kyle Pierce, DO¹, Hugo Pinillos, MD, FACG². P0975 - At a Crossroad of Chronicity: Crohn's Disease and Endometriosis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.