Acute Large Bowel Obstruction Caused by Endometriosis Requiring Sigmoidectomy

Abstract

Large bowel obstruction (LBO) accounts for nearly 25% of all bowel occlusions. LBO is managed as a surgical emergency due to its increased risk of bowel perforation. Nearly, 2% to 4% of all surgical admissions are a result of LBO. The most common pathological development of LBO remains colonic malignancy, representing approximately 60% of cases. Other etiology includes abdominal adhesions, diverticulosis, hernia, inflammatory bowel disease (IBD), and in rare cases endometriosis. In this report, the patient is a 36-year-old female with an LBO, originally thought to be a complication of diverticulitis. However, it was confirmed that the obstruction was a result of endometriosis tissue adherence to the colonic wall narrowing the intestinal lumen. The patient presented to the emergency department (ED) with nausea, vomiting, and abdominal pain that started six weeks prior. In this case report, we will discuss the rare complication of endometriosis causing LBO, clinical presentation, diagnosis, and management.

Keywords: laparoscopic surgery for endometriosis; large bowel obstruction; open decompression; sigmoid stricture; sigmoidectomy.

Figure 1. Axial CT scan. Red arrows show severe distention of the small and large bowels. The orange arrow shows distention of the colon, with the cecum measuring nearly 8 cm in diameter.

CT, computed tomography

Figure 2. Coronal CT scan. Red arrows show severe distention of the small and large bowels. Yellow arrows show distention of the small bowel greater than 4 cm in diameter.

CT, computed tomography

Figure 3. Red arrows show endometrial tissue with a glandular structure embedded in the muscular layer of the colonic wall. The orange arrow shows the surrounding stroma. The blue arrow shows the muscular layer of the colon.