Rectal endometriosis presenting as toxic megacolon.

Area of Science:

• Gastroenterology
• Gynecology
• Surgical Pathology

Background:

• Extragenital endometriosis commonly affects the bowel, particularly the sigmoid colon and rectum.
• Clinical presentation varies, impacting management strategies and potentially leading to surgical emergencies like bowel obstruction.
• Endometriosis can cause severe complications, including toxic megacolon and transmural necrosis, due to progressive lumen obliteration.

Observation:

• A 41-year-old woman presented with acute abdomen, sepsis, and toxic megacolon due to complete large bowel obstruction.
• Her medical history included chronic abdominal pain managed with self-treatment.
• Pathology confirmed colonic endometriosis as the cause of obstruction, ischemia, and necrosis.

Findings:

• Colonic endometriosis can lead to severe bowel obstruction, ischemia, and transmural necrosis.
• Prompt and thorough clinical workup is essential to identify potential causes of colonic obstruction, including endometriosis.
• A multidisciplinary approach, incorporating surgical intervention, may benefit medically unresponsive endometriosis cases.

Implications:

• This case underscores the importance of considering intestinal endometriosis in the differential diagnosis of colonic obstruction.
• Early intervention in partial obstruction without ischemia may prevent progression to toxic megacolon and the need for colectomy.
• Timely management of endometriosis can avert life-threatening complications and avoid extensive surgical procedures.