From the Guidelines
Endometriosis is a rare cause of small bowel obstruction, accounting for a small percentage of all bowel obstruction cases, with the exact frequency not specified in the most recent and highest quality studies 1. When it does occur, it is typically associated with severe, deeply infiltrating endometriosis that has affected the intestinal tract. The obstruction occurs because endometrial tissue implants on the small bowel, leading to inflammation, scarring, and eventual narrowing of the bowel lumen. This process can cause partial or complete blockage of intestinal contents. Some of the key symptoms that may indicate bowel obstruction in patients with endometriosis include:
- Cyclic abdominal pain
- Bloating
- Nausea
- Vomiting
- Changes in bowel habits Treatment typically requires surgical intervention to remove the affected bowel segment, often performed laparoscopically by a multidisciplinary team including gynecologists and colorectal surgeons 1. Hormonal therapies used for endometriosis management generally cannot resolve an established bowel obstruction. Women with known severe endometriosis should be aware of warning signs of bowel obstruction, including severe abdominal pain, persistent vomiting, and inability to pass gas or stool, which require immediate medical attention. According to the most recent study on suspected small-bowel obstruction, imaging plays a key role in the diagnosis and management of SBO, and can aid in the differentiation of high-grade from low-grade obstruction 1. In terms of the frequency of endometriosis causing small bowel obstruction, while the exact percentage is not specified in the most recent studies, it is considered a rare cause of bowel obstruction, with other causes such as adhesions, hernias, and malignancies being more common 1.
From the Research
Frequency of Endometriosis Causing Small Bowel Obstruction
- The prevalence of intestinal endometriosis has been estimated to be between 3% and 37% of all endometriosis cases 2.
- Cases of intestinal occlusion due to endometriosis foci on the small bowel and on the large bowel are even rarer, with a reported prevalence of 0.1-0.7% 2.
- A literature review found that the occlusive endometrial foci were localized on the ileum in 38.3% of the cases, which can cause small bowel obstruction 2.
Reported Cases of Small Bowel Obstruction Due to Endometriosis
- A case report described a 54-year-old postmenopausal woman who presented with severe abdominal pain and vomiting due to small bowel obstruction caused by endometriosis 3.
- Another case report described a 44-year-old lady who presented with acute small bowel obstruction due to endometriosis, which was initially thought to be irritable bowel syndrome 4.
- A case report also described a 34-year-old nulligravid female with progressive severe symptomatic endometriosis who developed intestinal obstruction shortly after preoperative administration of a GnRH analogue 5.
Diagnosis and Management of Bowel Endometriosis
- Several techniques have been proposed for the evaluation of patients with suspected bowel endometriosis, including transvaginal and/or transrectal ultrasonography, magnetic resonance imaging, and double-contrast barium enema 6.
- Surgery should be performed by experienced surgeons, in centers with access to multidisciplinary care, and treatment should be tailored according to patient symptoms and wishes 6.
- A literature review found that the mechanisms of obstruction include the presence of a mass in the lumen of the intestine or in the wall of the intestine, extrinsic compression, adhesions, or intussusception 2.