Endometriosis with an acute colon obstruction: a case report

Area of Science:

• Gastroenterology
• Gynecology
• Surgical Oncology

Background:

• Endometriosis typically presents with chronic symptoms, rarely manifesting as an acute bowel obstruction requiring emergency intervention.
• Acute presentations of endometriosis are infrequent, with limited literature describing cases necessitating emergency surgery.

Observation:

• A 31-year-old woman with a 14-year history of chronic abdominal pain and constipation presented with acute abdominal distension, pain, and nausea.
• Imaging revealed a severely distended cecum and sigmoid stenosis, leading to a diagnosis of likely cecal blowout.
• Emergency laparotomy identified an obstructing sigmoid process consistent with endometriosis.

Findings:

• Pathological examination of the sigmoid tumor revealed features characteristic of endometriosis, including tubelike structures and stromal elements.
• The patient underwent sigmoid resection with primary anastomosis and loop ileostomy.

Implications:

• Infiltrating endometriosis can mimic other conditions, emphasizing the importance of considering it in the differential diagnosis of acute bowel obstruction in women of childbearing age.
• Emergency physicians and surgeons must be vigilant for endometriosis presenting acutely.
• Emergency surgery is the preferred treatment for complete bowel obstruction caused by endometriosis, following initial colonoscopy.