Rectal endometriosis causing colonic obstruction and concurrent endometriosis of the appendix: a case report

A 36-year-old Greek woman was admitted to the emergency room of our hospital with signs of acute abdomen. On physical examination, our patient had a painful distended abdomen. Digital examination revealed an empty rectum and bowel obstruction was diagnosed. Our patient underwent exploratory laparotomy and rectum stenosis (almost complete obstruction) was observed. The bowel stenosis was resected, and temporary colostomy and appendectomy were performed. The pathology report showed endometriosis of the colon and the appendix, and our patient received medical treatment for endometriosis. Six months after this operation our patient had another surgery for restoration of large bowel continuity. No endometriosis was found. Our patient was doing well at the one-year follow up.Endometriosis of the bowel is a disease that may cause large bowel obstruction. In women of reproductive age, the surgeon should consider endometriosis as a differential diagnosis in case of various gastrointestinal symptoms.Endometriosis is a clinical entity, which was first described by von Rokitansky Kitansky as the presence of functioning endometrial tissue at sites outside the uterus [1,2]. Endometriosis occurs in 3-10% of the general female population of reproductive age, 40-80% present symptoms such as pelvic pain, infertility, or both [2,3]. Endometriosis rarely involves the small intestine, the appendix, the colon, the lung or other tissues [4,5].Bowel endometriosis is usually asymptomatic, but it may show non-specific symptoms, such as abdominal colic-like pain, nausea, vomiting, and general symptoms of intestinal obstruction [6,7]. Circumferential endometriosis of the rectum should be differentially diagnosed from inflammatory or malignant diseases [5]. Endometriosis of the appendix usually presents with abdominal pain [8]. The presence and/or association of appendiceal endometriosis, concomitant with rectal endometriosis, is possible, because endometriosis could occur in more than one anat