P0379 - The Womb Wanders to the Bowel: An Uncommon Case of Large Bowel Obstruction Secondary to Intestinal Endometriosis

Award: Presidential Poster Award

Nihal I. Khan, MD, Arooj Mian, MD, Mohamad Sharbatji, MD
AdventHealth Medical Group, AdventHealth, Orlando, FL

Introduction: Endometriosis is a common condition among premenopausal women. On rare occasions it may cause bowel obstruction when endometrial tissue is implanted in the intestines. Herein we report a case of large bowel obstruction secondary to intestinal endometriosis found in the rectosigmoid colon.

Case Description/Methods: A 30-year-old female with a past medical history of chronic constipation presented to the ED with a complaint of left lower quadrant abdominal pain and obstipation for six days. She underwent a CT of the abdomen and pelvis that demonstrated distal colonic obstruction secondary to a rectosigmoid mass that was contiguous with the uterus, along with left ureteral entrapment causing hydroureteronephrosis. MRI of the rectum was obtained revealing findings favoring diffuse pelvic endometriosis with involvement of the rectosigmoid area. CA-125 was mildly elevated (41.0) though CEA was normal (0.7). Colorectal surgery, gynecology, and urology teams were consulted, and they proceeded with a collaborative surgical endeavor. This involved flexible sigmoidoscopy that was abandoned due to external compression limiting passage of the scope as well as a diagnostic laparoscopy during which a loop colostomy was created, biopsies of uterine implants were obtained, and a left ureteral stent was placed. Biopsies of the sigmoid colon revealed endometriosis and chronic inflammation without malignant features. Postoperatively, the patient tolerated a regular diet with normal output in her ostomy and she was cleared for discharge on GnRH agonist treatment with outpatient follow-up.

Discussion: Intestinal endometriosis increases the risk of bowel obstruction, irrespective of the presence of intra-abdominal adhesions. These intestinal foci of endometrial tissue favor the rectosigmoid colon, as in our patient, given its proximity to the pouch of Douglas. The obstruction mechanism may involve intra-luminal blockage or external compression. Laparoscopic intervention for resection of implants and biopsy is imperative to the management of this condition, given its features resemble malignancy which needs to be ruled out. Our case underscores the importance of considering intestinal endometriosis as a differential etiology for bowel obstruction in all women of childbearing age, as well as the significance of multi-disciplinary care in its management.



Disclosures:


Nihal I. Khan, MD, Arooj Mian, MD, Mohamad Sharbatji, MD. P0379 - The Womb Wanders to the Bowel: An Uncommon Case of Large Bowel Obstruction Secondary to Intestinal Endometriosis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.