Ileal endometriosis with a recurrence of intestinal obstruction during menstruation

Yoshiki Ikeda, Kota Umemura, Ryosuke Uekusa, Atsushi Kunishima, Seiko Matsuo, Satoru Katsuki, Kei Fujita, Atsushi Yabuki, Kazuhisa Kitami, Misa Yoshida, Yosuke Kawai, M Takano, Mayumi Okada, Hisao Ando, Michiyasu Kawai
In: JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY · 2016 · vol. 32(1) , pp. 296–302 · doi:10.5180/jsgoe.32.296 · W2578950864
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⚙ AI-generated summary by claude@2026-06, 2026-06-13 ⓘ

This case report details a successful laparoscopic resection of ileal endometriosis and ovarian endometrioma in a patient experiencing recurrent intestinal obstruction during menstruation.

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This paper reports a case of ileal endometriosis in a 34-year-old woman with a left ovarian endometrioma who experienced repeated intestinal obstruction specifically during menstruation, confirmed by CT showing distal ileal stenosis. After conservative management of an initial obstruction, she underwent laparoscopic cystectomy of the ovarian endometrioma, but she relapsed with intestinal obstruction during the next menstruation; the paper notes that the planned operation timing could be affected, potentially requiring delay or conversion to laparotomy. To prevent further recurrence, she received dienogest for one month before surgery and then had concurrent laparoscopic resection of the ovarian endometrioma and ileal endometriosis without further obstruction, with pathology confirming both lesions and no recurrence detected for one year. This paper is centrally about endometriosis — specifically ileal endometriosis causing recurrent menstrual-associated intestinal obstruction and perioperative management using dienogest.

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Abstract

Bowel endometriosis sometimes causes repeated intestinal obstruction during menstruation. Recently, there are an increasing number of cases of bowel endometriosis treated with laparoscopic bowel resection. We had a case of ileal endometriosis with recurrence of intestinal obstruction during menstruation. A 34 year-old woman was referred with a left ovarian endometrioma 4 cm in diameter. She had just recovered from conservative treatment of intestinal obstruction, which had developed during menstruation. We planned a laparoscopic cystectomy of her left ovarian endometrioma. She relapsed with intestinal obstruction during menstruation, which was again treated conservatively. Computed tomography at the onset of intestinal obstruction showed stenosis of the distal ileum. Ileal endometriosis was suspected as the cause of this stenosis. Her next menstrual period was estimated to overlap with the planned laparoscopic operation. Another recurrence of intestinal obstruction during her next menstruation could necessitate a delay in the operation, or a conversion to laparotomy. She was treated with dienogest for prevention of intestinal obstruction recurrence for one month before the operation. Concurrent laparoscopic resection of the left ovarian endometrioma and ileal endometriosis was performed as scheduled without recurrence of intestinal obstruction. Pathological examination confirmed ileal endometriosis and left ovarian endometrioma. No recurrence of either ovarian endometrioma or intestinal obstruction has been detected for one year after the operation. Our experience suggests that it would be better to avoid planning laparoscopic surgery during menstruation in suspected bowel endometriosis, or to start drug treatment to prevent endometriosis-associated bowel obstruction.
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症例報告 月経時に腸閉塞を繰り返した回腸子宮内膜症の一例 2016 年 32 巻 1 号 p. 296-302 詳細 抄録 Bowel endometriosis sometimes causes repeated intestinal obstruction during menstruation. Recently, there are an increasing number of cases of bowel endometriosis treated with laparoscopic bowel resection. We had a case of ileal endometriosis with recurrence of intestinal obstruction during menstruation. A 34 year-old woman was referred with a left ovarian endometrioma 4 cm in diameter. She had just recovered from conservative treatment of intestinal obstruction, which had developed during menstruation. We planned a laparoscopic cystectomy of her left ovarian endometrioma. She relapsed with intestinal obstruction during menstruation, which was again treated conservatively. Computed tomography at the onset of intestinal obstruction showed stenosis of the distal ileum. Ileal endometriosis was suspected as the cause of this stenosis. Her next menstrual period was estimated to overlap with the planned laparoscopic operation. Another recurrence of intestinal obstruction during her next menstruation could necessitate a delay in the operation, or a conversion to laparotomy. She was treated with dienogest for prevention of intestinal obstruction recurrence for one month before the operation. Concurrent laparoscopic resection of the left ovarian endometrioma and ileal endometriosis was performed as scheduled without recurrence of intestinal obstruction. Pathological examination confirmed ileal endometriosis and left ovarian endometrioma. No recurrence of either ovarian endometrioma or intestinal obstruction has been detected for one year after the operation. Our experience suggests that it would be better to avoid planning laparoscopic surgery during menstruation in suspected bowel endometriosis, or to start drug treatment to prevent endometriosis-associated bowel obstruction. © 2016 日本産科婦人科内視鏡学会

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