Laparoscopic Triple Segmental Bowel Resection for Endometriosis Revealed by Rectal Obstruction during Infertility Treatment

Abstract

Intestinal endometriosis is a benign disease characterized by ectopic growth of the endometrium and causes extensive fibrosis and adhesions in response to repeated episodes of bleeding and inflammation with the menstrual cycle. We encountered a rare case of intestinal endometriosis that caused complete rectal obstruction in a 34-year-old woman undergoing infertility treatment. Colonoscopy showed rectal stenosis and obstruction but no evidence of a tumor. Bowel obstruction due to endometriosis was diagnosed based on the history and imaging findings. Transanal decompression was performed. Subsequent laparoscopic surgery revealed severe inflammation around both ovaries and a tumor-like rectal stenosis. Similar findings were obtained in the transverse colon and terminal ileum. We performed laparoscopic low anterior resection, partial transverse colon resection, ileocecal resection, bilateral cystectomy, and left salpingectomy. Infertility treatment was restarted and resulted in a successful term pregnancy. The patient remains well. Laparoscopic surgery, which has the advantage of being minimally invasive, allows for early postoperative recovery and discharge in patients with endometriosis; furthermore, the uterus and adnexa can be preserved due to the magnifying effect of the laparoscope. In this case, it was possible to resume infertility treatment. Intestinal endometriosis is a rare cause of bowel obstruction, but should be kept in mind if intestinal obstruction occurs during infertility treatment. Laparoscopic surgery may be useful for multiple endometriotic lesions and serve as a bridge to infertility treatment.

Endometriosis as an Uncommon Cause of Intestinal Obstruction—A Comprehensive Literature Review

“…Out of 107 patients, 26 were previously diagnosed with endometriosis, while the rest (81 patients) were diagnosed with endometriosis in the context of an intestinal occlusion event. In five cases, patients had a history of in vitro fertilization [21,[26][27][28].…”

“…The mean age of patients diagnosed with LBO due to rectal endometriosis (11 patients) [27,[89][90][91][92][93][94][95][96][97] was 38.45, with a minimum of 26 and a maximum of 50. Nine underwent emergency surgery, consisting of a total colectomy in one patient, a colostomy without any type of resection in three patients, anterior rectal resection in three patients, and rectosigmoid resection in four patients.…”