Endometriosis is characterized by an extrauterine presence of endometrial-like glands and stroma, commonly involving the ovaries, tubes, and pelvic peritoneum. Women with endometriosis can be asymptomatic or present with various symptoms including dysmenorrhea, pain, and dyspareunia whereas intestinal obstruction is uncommon.
Case presentation:
We present a 43-year-old female with acute large bowel obstruction (LBO), originally thought to be a complication of sigmoid cancer. During exploration, an obstructive mass including the sigmoid and upper rectum was identified, it was adherent to the uterus and the ovaries. Sigmoidectomy, panhysterectomy, and end colostomy were performed. Microscopic examination of the rectosigmoid mass revealed endometrial glands and stroma along with areas of hemorrhage, and hemosiderin deposition with some inflammatory cells. Three pericolic lymph nodes were involved with endometriosis.
Conclusion:
Despite the rare association, endometriosis can be a possible cause of intestinal obstruction, posing a diagnostic challenge because it is easily confused for malignant LBO.
MitchellAMLensenSKamperSJ, et al. The most impactful endometriosis symptom: an international, cross-sectional, two-round survey study. Acta Obstet Gynecol Scand2024; 103(9): 1736–1744.
5.
FacchinFBarbaraGSaitaE, et al. Impact of endometriosis on quality of life and mental health: pelvic pain makes the difference. J Psychosom Obstetr Gynecol2015; 36(4): 135–141.
6.
Sarria-SantameraAOrazumbekovaBTerzicM, et al. Systematic review and meta-analysis of incidence and prevalence of endometriosis. Healthcare2021; 9: 29.
7.
KatsikogiannisNTsarouchaAKDimakisK, et al. Rectal endometriosis causing colonic obstruction and concurrent endometriosis of the appendix: a case report. J Med Case Rep2011; 5: 320.
8.
AciénPVelascoI.Endometriosis: a disease that remains enigmatic. ISRN Obstet Gynecol2013; 2013: 1–12.
9.
RamanathanSOjiliVVassaR, et al. Large bowel obstruction in the emergency department: imaging spectrum of common and uncommon causes. J Clin Imaging Sci2017; 7: 15.
10.
AllanZ.A case of endometriosis causing acute large bowel obstruction. Int J Surg Case Rep2018; 42: 247–249.
11.
SohrabiCMathewGMariaN, et al. The SCARE 2023 guideline: updating consensus Surgical CAse REport (SCARE) guidelines. Int J Surg2023; 109(5): 1136–1140.
12.
CousinsFLMcKinnonBDMortlockS, et al. New concepts on the etiology of endometriosis. J Obstetr Gynaecol Res2023; 49(4): 1090–105.
13.
SampsonJA.Peritoneal endometriosis due to the menstrual dissemination of endometrial tissue into the peritoneal cavity. Am J Obstet Gynecol1927; 14(4): 422–469.
14.
SampsonJA.Heterotopic or misplaced endometrial tissue. Am J Obstet Gynecol1925; 10(5): 649–664.
15.
LamcevaJUljanovsRStrumfaI.The main theories on the pathogenesis of endometriosis. Int J Mol Sci2023; 24(5): 4254.
BattREYehJ.Müllerianosis: four developmental (embryonic) müllerian diseases. Reprod Sci2013; 20(9): 1030–1037.
18.
TempferCBWenzlRHorvatR, et al. Lymphatic spread of endometriosis to pelvic sentinel lymph nodes: a prospective clinical study. Fertil Steril2011; 96(3): 692–696.
19.
JermanLFHey-CunninghamAJ.The role of the lymphatic system in endometriosis: a comprehensive review of the literature. Biol Reprod2015; 92(3): 64.
20.
NoëlJCChapronCFaytI, et al. Lymph node involvement and lymphovascular invasion in deep infiltrating rectosigmoid endometriosis. Fertil Steril2008; 89(5): 1069–1072.
21.
InsabatoLPettinatoG.Endometriosis of the bowel with lymph node involvement. A report of three cases and review of the literature. Pathol Res Pract. 1996;192(9):957–61.
22.
AbraoMSPodgaecSDiasJAAverbachMGarryRFerraz SilvaLF, et al. Deeply infiltrating endometriosis affecting the rectum and lymph nodes. Fertil Steril. 2006 Sep;86(3):543–7.
23.
MylonkiasEMaroufidisEKlimisGGlynatsisM.deeply infiltrating endometriosis of the sigmoid and lymph node simulating obstructive neoplasm. Hellenic journal of surgery. 2010 Oct;82(5):337–41.
24.
InsillaACGranaiMGallippiGGiustiPGiustiSGuadagniS, et al. Deep endometriosis with pericolic lymph node involvement: A case report and literature review. World J Gastroenterol. 2014;20(21):6675–9.
25.
LeeHJParkYMJeeBCKimYBSuhCS.Various anatomic locations of surgically proven endometriosis: A single-center experience. Obstet Gynecol Sci. 2015;58(1):53.
26.
LozneanuLCiobanu-ApostolDGAnca BalanRPăvăleanuIGiuşcăSECăruntuID, et al. Multifocal endometriosis [Internet]. Vol. 3, Arch Clin Cases. 2016. Available from: www.clinicalcases.eu
27.
’BahirwaniJPatelDStollLsarinaKapoor. s1624 endometriosis of the colon and pericolic lymph node presenting as cecal volvulus : A case report. journal of American college of gastroenterology. 2020 Oct;115:s833–4.
28.
PašalićETambuwalaMMHromić-JahjefendićA.Endometriosis: classification, pathophisiology, and treatment options. Pathol Res Pract2023; 251: 154847.
29.
CalcagnoPVitiMCornelliA, et al. Intestinal obstruction caused by endometriosis: endoscopic stenting and expedited laparoscopic resection avoiding stoma. A case report and review of the literature. Int J Surg Case Rep2018; 44: 75–77.
30.
ValarmathiM.Study of acute intestinal obstruction management and its outcome. Int Surg J2021; 8(12): 3535.
