S2954 Endometrioma: An Unlikely Cause of Small Bowel Obstruction

Introduction: Endometriosis is a common disease defined by the presence of endometrial glands outside of the uterus. Although it usually involves gynecological locations, it can also manifest in other visceral organs, like the bowel, in up to 37% of patients. We present a case of partial small bowel obstruction secondary to an endometrioma requiring surgical resection. Case Description/Methods: A 38-year-old white female presented to the emergency department complaining of acute abdominal pain with nausea and vomiting. The patient's pain was described as crampy and located in her mid-abdomen and lower pelvis. The patient also reported a similar episode one year prior that required hospitalization with subsequent recurrent episodes of crampy abdominal pain every 2-3 months since discharge. During that previous admission patient was found to have a partial bowel obstruction in her terminal ileum that was managed conservatively. On this admission, patient's vital signs were unremarkable and she was found to have an elevated white blood cell count of 13.4 x 103/μL. Abdominal examination revealed a soft, slightly distended abdomen with hyperactive bowel sounds and abdominal CT showed a distal partial small bowel obstruction. General Surgery was consulted and later took the patient for a diagnostic laparoscopy and possible small bowel resection. Intra-operatively an area in the distal ileum was found to be consistent with a small bowel tumor of unknown etiology. The patient then underwent a small bowel resection with the mass being sent to pathology for frozen section. Post-op pathology results later revealed the mass to be an endometrioma and after symptomatic resolution, the patient was discharged home with follow-up with gynecology for her newly diagnosed endometriosis. Discussion: Endometriosis is a disease in which ectopic endometrial tissue infiltrates and proliferates within abdominal viscera leading to inflammation and fibrosis. The most common sites of involvement includes the ovaries, fallopian tubes, and the utero-sacral and large ligaments. Although 12% of patients will have bowel involvement, most patients remain asymptomatic or will present with non-specific symptoms. Infrequently, in less than 1% of all patients, some present with small bowel obstruction. Diagnosis of bowel endometriosis is challenging, and even in those without a history of endometriosis, it should remain a differential in all women of reproductive age complaining of acute abdominal pain with signs of bowel obstruction.