Publication:

Small bowel obstruction due to subserosal endometriosis: an elusive condition

The bowel is involved in 3.8 to 37% of women with endometriosis, out of which nearly 1% present with signs of bowel obstruction to the surgeon. This report describes a case of acute small bowel obstruction in a 23 years old woman. The patient gave a history of intermittent episodes of pain abdomen and abdominal distension for the past 1 year with significant loss of weight. The menstrual cycles were normal. Although there was no history of Tuberculosis, a positive history of contact was present. The clinical and biochemical picture was suggestive of peritonitis. CECT of the abdomen revealed a long segment distal ileal stricture. With a provisional diagnosis of Tubercular Ileo-Caecal stricture perforation, a midline exploratory laparotomy was performed. The procedure consisted of right limited hemicolectomy and primary ileo-ascending anastomosis with a proximal loop ileostomy. Ileostomy was done to allow the healing of distal anastomosis and closure was done after 4 weeks. Histopathology of the resected segment of ileum revealed subserosal endometriosis. Postoperatively, the patient was not given any hormonal therapy and recovery has been uneventful over the past 1 year of follow up.