Impending caecal blowout due to endometriosis

Background: Endometrial tissue is present outside the uterine cavity in 6-10% of fertile women. Associated symptoms such as dysmenorrhoea, dyspareunia and abdominal discomfort are non-specific. For this reason, endometriosis is not always considered in women with abdominal symptoms. Endometriosis can also manifest itself as an acute surgical emergency such as an intestinal obstruction. Case description: A 29-year-old woman was admitted to our hospital with acute lower abdominal pain and vomiting. On rectal examination a firm mass was palpable. CT scan of the abdomen showed the loops of colon to be extremely dilated. As a caecal blowout seemed imminent we carried out a laparotomy which revealed an obstruction of the rectum caused by severe endometriosis. Conclusion: In fertile women presenting with signs of acute bowel obstruction, endometriosis should be included in the differential diagnosis and an early gynaecological consultation is indicated.