Garan Phrommee, M.D.
Department of Anatomical Pathology, Chaopraya Abhaibhubhejr Hospital, Prachinburi, Thailand
A woman, age thirty-eight years old, came to the hospital with acute diarrhea and complained of having severe
abdominal pain for two days. She had no underling disease and no history of alcohol or tobacco usage. She
previously had surgery for a fracture of the right femur. The physical examination recorded a 38.2oC body
temperature, a blood pressure of 139/88 mmHg, a pulse of 126 and a respiratory rate of 22/minute. The
laboratory investigations showed leukocytosis with predominance of neutrophils, glucosuria and proteinuria.
An acute abdomen series was performed and the resulting radiologic fi ndings showed marked distension
of the supine view, air-fl uid level of the upright view, and no free air under the diaphragm. A Hartmann’s
operation was done resulting in a colonic resection of 16 cm. The gross examination showed a bulging
mass which measured 4 cm in diameter. The mass was 4 cm and 8 cm from both surgical resection margins.
The histologic fi ndings showed endometrial glands embedded in the fi brotic tissue. The evidence of malignancy
was not found. The concluding diagnosis was endometriosis externa with clinical gut obstruction.