Acute small bowel obstruction secondary to intestinal endometriosis, an elusive condition: a case report

We present the case of a 33 year old female of Asian origin who presented with symptoms and signs of an acute small bowel obstruction. A right hemicolectomy for suspected malignancy was performed with an ileocolic anastomosis. Histological examination demonstrated extensive endometriosis of the appendix and ileocaecal junction.Enteric endometriosis should be considered as a differential diagnosis when assessing females of reproductive age with acute small bowel obstruction. A high index of suspicion is required to arrive at a diagnosis of this elusive condition.Endometriosis is a benign condition, affecting 4 to 17% of menstruating women. It has a peak incidence in the third and fourth decade. Its aetiology is unknown, although there is a high incidence in sterile females as well as in those who have a family history [1,2]. It is characterized by the presence of extra-uterine endometrial tissue. Endometriosis affects the intestine in 3 to 12% of cases and is generally an asymptomatic condition [1]. In rare circumstances, it can lead to obstruction requiring surgery. Clinically, the symptoms of bowel endometriosis are numerous and include abdominal pain, rectal pain, tenesmus, per rectal bleeding and constipation. Classically, the symptoms are worse during menses, but this is not always the case. This myriad of symptoms can make the condition difficult to diagnose acutely. We present a rare case of an acute small bowel obstruction secondary to ileocaecal and appendiceal endometriosis. This report serves as a reminder of this rare condition as well as highlighting the diagnostic difficulties it can pose.A 33 year old woman of Asian origin was admitted to our Colorectal Unit with a one day history of absolute constipation and haematochesia. This was associated with a one week history of emesis that had gradually increased in severity. The patient was complaining of a one month history of generalised colicky abdominal pain. On the day of admission, the pain was describe