Small-bowel obstruction secondary to endometriosis

Though endometriosis is a frequent finding in females, it rarely causes obstruction of the small bowel. However, 11 patients with such obstruction were seen at the Mayo Clinic in the years 1950 through 1970. Their ages ranged from 27 years to 51. A portion of involved bowel had to be resected in every case, but most of the lesions were single. Generally the obstructions were subacute and did not produce surgical emergencies. But because the symptoms were neither specific nor acute, the diagnosis seldom was established prior to laparotomy and the majority of the resections were performed without bowel preparation. Nevertheless, morbidity was minor in most cases and there was no mortality. Small-bowel obstruction has not recurred. Endometriosis of the small bowel tends to be limited to the serosa and the muscular coats, not penetrating the mucosa; and obstruction is due to fibrosis and kinking of the bowel. The obstructed segment usually must be resected. If pelvic endometriosis is minimal, no further surgery is necessary. But if the pelvic lesions are extensive, or if multiple sites in the small and large intestines are involved, then more radical resection and bilateral oophorectomy are indicated.