Intestinal endometriosis: A rare cause of acute care surgery

Intestinal endometriosis is a rare condition that can cause gastrointestinal symptoms such as abdominal pain, constipation, and diarrhea. It occurs in approximately 5%-15% of women with endometriosis. Although it rarely leads to obstruction or perforation, there is no clear consensus on its optimal management. Hormonal therapy is considered the first-line treatment for endometriosis; however, the best approach for intestinal involvement remains controversial. This study aims to contribute to the literature by evaluating patients with intestinal endometriosis who underwent surgery for acute abdomen.

Sixteen patients who underwent emergency surgery for acute abdomen at the Emergency General Surgery Clinic of İstanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty of Medicine, between February 2016 and April 2023 were identified. Four patients voluntarily withdrew from the study, and 12 were included in the analysis. Demographic data, laboratory findings, surgical records, length of hospital stay, pathology reports, postoperative complications within the first 30 days, and their management were reviewed. Patients' current health status was assessed through telephone interviews.

The mean age of the patients was 39.3+-9.2 years. Nine patients underwent surgery with a preoperative diagnosis of intestinal obstruction, while three were operated on for suspected acute appendicitis. Among the patients with intestinal obstruction, three underwent laparoscopic ileocecal resection, and three had segmental small bowel resection. One patient underwent anterior resection with appendectomy, and another underwent both anterior resection and ileocecal resection with ileocolostomy. One patient underwent a left hemicolectomy. The mean hospital stay was 7.9+-5.9 days. Postoperative complications occurred in three patients (25%). The mean age of patients who experienced complications was significantly higher than that of those who did not (p<0.007). Histopathological examination revealed benign full-thickness endometriosis in all cases. The mean follow-up period was 50.6 months, with no recurrences observed.

Acute abdomen due to intestinal endometriosis-related obstruction is extremely rare. In reproductive-aged women presenting with acute abdomen, intestinal endometriosis should be considered in the differential diagnosis. In cases of clinical suspicion, intraoperative consultation with a gynecologist is recommended, and a multidisciplinary approach should be adopted to optimize treatment planning.