Ileal endometriosis with a recurrence of intestinal obstruction during menstruation

Abstract

  Bowel endometriosis sometimes causes repeated intestinal obstruction during menstruation. Recently, there are an increasing number of cases of bowel endometriosis treated with laparoscopic bowel resection. We had a case of ileal endometriosis with recurrence of intestinal obstruction during menstruation. A 34 year-old woman was referred with a left ovarian endometrioma 4 cm in diameter. She had just recovered from conservative treatment of intestinal obstruction, which had developed during menstruation. We planned a laparoscopic cystectomy of her left ovarian endometrioma. She relapsed with intestinal obstruction during menstruation, which was again treated conservatively. Computed tomography at the onset of intestinal obstruction showed stenosis of the distal ileum. Ileal endometriosis was suspected as the cause of this stenosis. Her next menstrual period was estimated to overlap with the planned laparoscopic operation. Another recurrence of intestinal obstruction during her next menstruation could necessitate a delay in the operation, or a conversion to laparotomy. She was treated with dienogest for prevention of intestinal obstruction recurrence for one month before the operation. Concurrent laparoscopic resection of the left ovarian endometrioma and ileal endometriosis was performed as scheduled without recurrence of intestinal obstruction. Pathological examination confirmed ileal endometriosis and left ovarian endometrioma. No recurrence of either ovarian endometrioma or intestinal obstruction has been detected for one year after the operation. Our experience suggests that it would be better to avoid planning laparoscopic surgery during menstruation in suspected bowel endometriosis, or to start drug treatment to prevent endometriosis-associated bowel obstruction.