Intestinal obstruction by deep enteric endometriosis: case report and literature review

Deep endometriosis (DE) is an uncommon cause of bowel obstruction; preoperative diagnosis is a challenging task due to its rarity and pathological confirmation. Surgery is the appropriate treatment and complications are common. A 26-year-old Latin female was admitted to emergency department with 72 hours history of abdominal pain associated with inability to pass stool or gas, vomiting and nausea. Abdominal distention and pain without acute abdomen signs. Laboratory tests reported normal. Abdominal contrast-enhanced computed tomography showed distal small bowel obstruction. Patient underwent exploratory laparotomy with segmental resection bearing ileal strictures and Brook´s ileostomy was performed. Postoperative course of patient was uneventful and after pathology report treatment with dienogest was established. DE remains challenging entity to treat, medical treatment can reduce symptoms, but surgical resection is required. Bowel resection is reserved for mayor stenosis lesions. Anastomotic leakage is frequent. Surgery represents the definitive treatment for bowel obstruction by DE. Resection improves pain and intestinal symptoms. Recurrence, stenosis, and anastomotic leakage rates vary across the studies. Surgical and medical treatment should be considered