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Intestinal obstruction due to rectal endometriosis
Melih Paksoy1, Ilhan Karabiçak, Fadil Ayan
1Department of General Surgery, Cerrahpasa Medical Facility, Istanbul University, Istanbul, Turkey.
The Mount Sinai Journal of Medicine, New York
|December 17, 2005
Summary
Rectal endometriosis can cause severe constipation and bowel obstruction in premenopausal women. Diagnosis is challenging as colonoscopies are often non-diagnostic, making surgery crucial for definitive identification.
Area of Science:
- Gastroenterology
- Gynecology
- Surgical Pathology
Background:
- Severe constipation and intermittent bowel obstruction are significant clinical challenges.
- Premenopausal women with these symptoms require thorough differential diagnosis.
- Rectal strictures of unknown etiology necessitate comprehensive investigation.
Observation:
- A premenopausal woman presented with severe constipation and intermittent bowel obstruction.
- Colonoscopy identified a tight rectal stricture, but biopsies showed normal mucosa.
- Exploratory surgery revealed extensive fibrotic reaction involving the rectum and uterus.
Findings:
- Pathology confirmed endometriosis as the cause of the fibrotic reaction and rectal stricture.
- Endometrial implants typically do not invade the rectal mucosa, explaining non-diagnostic biopsies.
- Surgical intervention was required for both diagnosis and treatment (low anterior resection and hysterectomy).
Implications:
- Rectal endometriosis should be considered in the differential diagnosis of rectal strictures in premenopausal women.
- Non-invasive diagnostic methods for rectal endometriosis are limited.
- Surgical exploration may be essential for definitive diagnosis and management of severe cases.