Intestinal Obstruction due to Rectosigmoid Endometriosis Mimicking Stenotic Rectosigmoid Cancer: A Case Report

Abstract

Endometriosis is the presence of endometrial-like tissues (glands and stroma) outside the uterine  cavity. It is a common cause of  morbidity in women of reproductive age (up to 10%). Endometriosis  may affect a variety of organs including the intestines (5-12% of  endometriotic women). About 90% of  intestinal endometriosis involves the rectosigmoid colon and may be symptomatic or  asymptomatic.  Bowel obstruction occurs in less than 1% of patients with endometriosis. This is a report of a 32-yearold female who  presented with altered bowel habits of 6 months, abdominal pain with obstipation of 11  days, vomiting of 10 days, and abdominal  distension of 8 days. She has had severe cyclical lower  abdominal pains for two years and primary infertility of 6 years. Physical  examination findings were in  keeping with intestinal obstruction. She was optimized for surgery with intraoperative findings of a  hard  complex mass comprised of the rectosigmoid colon, uterus and adnexae; dilated proximal colon  and collapsed Small intestines. She had  a multi-stage resection and anastomosis of the rectosigmoid  colon and bilateral wedge resection of the ovaries. Histology of the  resected specimen revealed  endometriosis. She is doing well after discharge with relief of symptoms; however, she is still being  managed for Infertility. In conclusion, endometriosis though benign may have crippling physical  and/or psychosocial effects on women  of reproductive age. Recto-sigmoid endometriosis may be  considered a rare differential diagnosis of bowel obstruction from recto- sigmoid cancer and may  require a multi-stage surgical approach as appropriate. Management of endometriosis-associated  infertility is  challenging