Rectal perforation from endometriosis in pregnancy: Case report and literature review

Abstract

This case report describes a woman with spontaneous rectal perforation from decidualized endometriosis in pregnancy. A 37-year-old woman was admitted to our hospital at 30 wk of pregnancy with symptoms suggestive of pyelonephritis, which persisted until 33 wk of gestation when delivery of a premature male baby was performed through a cesarean section. On postoperative day 2, an abdominal computed tomography showed free air in the peritoneal cavity and a pelvic abscess. Explorative celiotomy revealed a diffuse severe fecaloid peritonitis that originated from a 3-cm wide rectal perforation. A Hartmann operation was then performed. Histopathological findings were consistent with decidualization of the rectal wall. Only 20 cases of intestinal perforation due to endometriosis have been reported in the literature. This report is believed to be the first case of spontaneous rectal perforation from endometriosis in pregnancy, and it shows the potential occurrence of serious and unexpected complications of the disease.

The effect of the hormonal milieu of pregnancy on deep infiltrating endometriosis: serial ultrasound assessment of changes in size and pattern of deep endometriotic lesions

“…Actually, decidualization with the resultant decrease in size of a transmural endometriotic nodule may lead to perforation, by weakening of the intestinal wall, mainly during the third trimester [6]. On the other hand, transmural bowel wall involvement is not so common, the intestinal mucosa usually remains intact, and perforation of the affected intestinal tract is a very rare complication [6].…”

“…On the other hand, transmural bowel wall involvement is not so common, the intestinal mucosa usually remains intact, and perforation of the affected intestinal tract is a very rare complication [6].…”

Acute Small Bowel Obstruction and Small Bowel Perforation as a Clinical Debut of Intestinal Endometriosis: A Report of Four Cases and Review of the Literature

“…However, the presence of foci of intestinal endometriosis may cause a weakness in the affected region of the intestinal wall, facilitating its drilling secondary to peristalsis or traction phenomena of the intestinal wall (15).…”

Endometriosis of colon as a cause mimicking Crohn’s disease: a potential pitfall in diagnosis

“…Mainly, the disease affects women, however, there have been some cases of endometriosis in men with prostate cancer [9]. The disease can be found throughout the length of both the small and large intestines [2][3][4]10].…”

“…Its most common site is the peritoneal cavity. Endometriotic foci can also be found in many other organs, such as the lung, urinary bladder, retroperitoneal space and alimentary tract [1][2][3][4][5][6][7]. However, the colon is the most common ectopic focus.…”