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Case Reports
. 2023 Sep:110:108703.
doi: 10.1016/j.ijscr.2023.108703. Epub 2023 Aug 21.

A Diagnostic Conundrum - Small bowel obstruction from undiagnosed endometriosis following uterine perforation

Erina Horikawa  1 , Carmen R Abbe  2 , Brian E Staley  3 , Luay Ailabouni  4
Affiliations
Case Reports

A Diagnostic Conundrum - Small bowel obstruction from undiagnosed endometriosis following uterine perforation

Erina Horikawa et al. Int J Surg Case Rep. 2023 Sep.

Abstract

Introduction: Uterine perforation is a rare but recognized complication from dilation and curettage, a common therapeutic procedure for obstetric complications and emergencies. Limited cases exist on endometriosis occurring following rupture. Additionally, there are no reported cases of uterine rupture secondary to dilation and curettage leading to new onset endometriosis first presenting as a small bowel obstruction (SBO).

Presentation of case: A 42-year-old female with recurrent small bowel obstruction was found to have a stricture caused by endometriosis via diagnostic laparoscopy and pathology. Patient had a dilation and curettage for retained products of conception 11 years prior, complicated by uterine perforation. This patient never had a diagnosis of endometriosis prior to her SBO. Patient made an uneventful recovery after small bowel resection with resolving of SBO symptoms.

Discussion: Our case highlights the possibility of endometriosis due to previous uterine rupture as a cause for SBO in an otherwise healthy, female patient of reproductive age. There is a continued need for appropriate documentation of surgical complications on patient charts as well as considering postoperative complications when other etiologies of SBO are less likely.

Conclusion: Endometriosis should be considered as a differential in reproductive aged women presenting with a small bowel obstruction, with an increased index of suspicion if the patient has had previous obstetric surgical procedures.

Keywords: Endometriosis; Small bowel obstruction; Uterine perforation.

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Conflict of interest statement

Declaration of competing interest None.

Figures

Image 1
Image 1
Abdominal CT scans with contrast demonstrating a small bowel obstruction with a transition point in the right lower quadrant.
Image 2
Image 2
Abdominal CT scans with contrast demonstrating a small bowel obstruction with a transition point in the right lower quadrant.
Image 3
Image 3
Pathology from D&C in 2012 with large pieces of myometrium.
Image 4
Image 4
Photographed evidence of laparoscopic findings of tethering of ileum with endometriotic lesions at two separate locations.
Image 5
Image 5
Pathology of endometrial tissue from biopsy - endometriosis full thickness (top) and endometriosis at high power (bottom).
See this image and copyright information in PMC

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