Endometriosis as a rare cause of small bowel obstruction

Abstract

Endometriosis as a rare cause of small bowel obstruction Acute small bowel obstruction (SBO) secondary to intestinal endometriosis is a rare pathology that requires major surgery. Endometriosis can be a chronic painful disease characterized by the presence of functional endometrial tissue outside of the uterus. 1 It is important to think about endometriosis as a cause of an SBO. We present a 49-year-old female with a 12-h history of nausea, abdominal distension and postprandial pain. Diagnostic laparoscopy 2 years previously for generalized abdominal discomfort confirmed a grade 4 endometrioma. The patient managed her endometriosis medically with dienogest, a synthetic progesteronelike hormone. On examination, the abdomen examined soft but appeared distended. A computed tomography of the abdomen and pelvis revealed a high-grade SBO with a transition point in the distal ileum secondary to a suggested ovoid intraluminal density concerning for malignancy (Fig. 1). At laparotomy, 30 cm from the ileocaecal valve, the ileum could be seen twisting on itself in a ushape via an interloop adhesion. At the twist, a 2 × 2 cm intraluminal density was palpated. There was no obvious scarring of the serosa. Small bowel was distended proximal to the u-loop and collapsed distally. Histology confirmed evidence of endometriosis involving the serosa of the ileum (Fig. 2). Fifteen centimetres of ileum was resected with an end-to-end anastomosis performed. The patient had an uneventful post-operative recovery. Endometriosis causing an acute bowel obstruction occurs in <1% of patients with intestinal endometriosis. 2 When the gastrointestinal tract is involved, only 7% of cases involve the small bowel. 3 Fig. 1. Computed tomography of the abdomen and pelvis with intravenous contrast showing (a) axial and (b) coronal views. There is a high-grade mechanical small bowel obstruction in the distal small bowel secondary to an ovoid intraluminal density (arrows).