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