Case Report of a Patient With Acute Bowel Obstruction Caused by Endometriosis

Case Report of a Patient With Acute Bowel Obstruction Caused by Endometriosis

Researchers at the Flevoziekenhuis in The Netherlands recently reported a case of a woman suffering from acute bowel obstruction due to endometriosis. The study, entitled “Endometriosis with an acute colon obstruction: a case report”, was published in the Journal of Medical Case Reports.

Endometriosis is a gynecological disorder in which the tissue that normally lines the inside of the uterus (called endometrium) grows outside the uterus, usually in the abdominal cavity, where it can form lesions and cysts, scarring organs like the ovaries, bladder and rectum. The tissue, although displaced, still continues to act normally as inside the uterus, so it thickens, breaks down and bleeds with each menstrual cycle. Endometriosis can be a painful disorder, causing inflammation and very heavy periods. It is estimated that 5 to 10% of women in reproductive age suffer from this condition and it can cause infertility in up to 50% of the women. The exact causes of the disorder are unknown.

In the study, researchers report a case of a 31-year-old Caucasian woman who was admitted into the hospital’s emergency department with nausea, pain and increasing abdominal distension. The patient had a long history of abdominal pain and chronic constipation symptoms since she was 17. Blood tests were normal with no signs of infection. The patient was submitted to an abdominal X-ray and subsequent computed tomographic (CT) scan that revealed a significantly inflated cecum of 9 cm, with an obstruction in the sigmoid colon with distension of the colon.

Due to the risk of cecal blow-out, the team performed an emergency laparotomy, a surgical procedure involving an abdomen incision to gain access into the abdominal cavity. During the laparotomy, the team found an obstruction in the sigmoid colon; this sigmoid region was subsequently resected. The patient recovered quickly from surgery and was discharged from the hospital after one week.

A pathological analysis of the resected sigmoid revealed a tumor of 4 cm with characteristics that were found to be typical of endometriosis. The patient was then diagnosed with acute bowel obstruction caused by deep infiltrating endometriosis.

The team emphasizes that infiltrating endometriosis is a disabling disease that can be misdiagnosed for several other disorders, so physicians and surgeons should consider it as a possible diagnosis in women of childbearing age with acute bowel obstruction. Surgical intervention is considered the best treatment option.