A 45-year-old woman was admitted to our surgical department for the first time in November 2015, suffering from diffuse abdominal pain for over one month. She was also in amenorrhea without any other gynecologic symptoms. From 1988 she took the HAART (Highly Active Antiretroviral Therapy) for HIV infection with regular count of CD4 lymphocytes (last determination of the CD4 lymphocytes was 1005 (25.9%) and HIV viremia was not detectable). She had never been pregnant and had no abdominal surgery in her history. Before the recovery, the patient underwent an outpatient colonoscopy that reported a nontransitable severe stricture of the ascending colon that did not allow the execution of biopsies; the perilesion biopsies did not reveal any morphological specific alteration. During the recovery a CT with contrast medium was performed and a thickening of the wall of the terminal ileum/ascending colon compatible with inflammatory or lymphoproliferative disease was found (Figures 1 and 2). The treatment was only medical with fasting, infusions, antibiotics, and mesalamine (800 mg t.i.d.). One month later, after therapy with mesalamine, another colonoscopy was performed and confirmed the persistence of the stenosis. The patient still suffered severe abdominal pain and vomit. She was admitted to our department, an urgent laparotomy and a right hemicolectomy were performed. Intraoperative mass of the ascending colon occluded the intestinal transit without any adhesions with the other abdominal organs and no signs of endometriosis were found. The postoperative course was regular without complications. She was discharged on the eighth postoperative day. The histological examination on the specimen was "Crohn's Disease with outbreaks of endometriosis." CD10, usually positive in endometriosis, was used for histological diagnosis. The macroscopical appearance of the surgical specimen revealed a stenosis of the terminal ileum at the level of ileocecal valve with accumulation of pills of mesalamine in the distal ileum (Figures 3(a) and 3(b)). The histological evaluation revealed a typical CD with sectorial erosions, ulcerations, and inflammation of the mucosa with multiple lymphoid aggregates in the submucosa, muscularis propria, and serosa together with foci of endometriosis (estrogen and progesteron positive immunostain) (Figures 3(c)-3(h)).
The patient is now incorporated into a multidisciplinary team including Gastroenterologists, Infectious Diseases Specialists, and Gynecologists.