A Rare Cause of Colonic Obstruction: Endometriosis

Murat Özgür Kılıç, Orhan Kalaycı, Muhammed Fatih Çiçek, Melis Sirel Aslantaş
In: Turkish Journal of Surgical Oncology · 2026 · vol. 2(2) , pp. 74–77 · doi:10.4274/turkjsurgoncol.galenos.2026.44153 · W7164834699
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⚙ AI-generated summary by claude@2026-06, 2026-06-22 ⓘ

This case report details a 45-year-old woman who presented with a sigmoid colon obstruction caused by a deep infiltrating endometrioma, emphasizing endometriosis as a rare differential for colonic obstruction.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-22 ⓘ

This paper is a surgical case report of a 45-year-old woman presenting with two months of cramping lower abdominal pain, constipation, abdominal distension, and thin ribbon-like stools, ultimately found to have a near-obstructing sigmoid stricture. Using CT, colonoscopy (normal mucosa but an impassable stricture), intraoperative findings, and pathology with immunohistochemistry (CK7 and CD10 positivity; estrogen/progesterone positivity), the authors diagnosed deep infiltrating endometriosis causing mechanical colonic obstruction and performed sigmoid resection with lymph node dissection; they note limitations including non-specific symptoms/imaging that led to misdiagnosis as irritable bowel syndrome and the inability to biopsy due to perforation risk with intact mucosa. During a two-year follow-up, the patient remained asymptomatic and recurrence-free. This paper is centrally about endometriosis — specifically a rare presentation of deep infiltrating sigmoid endometriosis causing colonic obstruction.

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Abstract

Mechanical intestinal obstruction is a surgical emergency; colonic factors account for approximately one-fourth of cases.Endometriosis, characterized by the presence of endometrial tissue outside the uterine cavity, is an extremely rare cause of colonic obstruction.A 45-year-old woman presented with a two-month history of cramping lower abdominal pain, abdominal distension, constipation, and thin, ribbon-like stools.Computed tomography showed an obstructing mass in the sigmoid colon with mildly dilated intestinal loops.Colonoscopy revealed an impassable stricture with normal mucosa located approximately 30 cm from the anal verge.During the operation, a sigmoid resection with lymph node dissection was performed.Pathological examination revealed a submucosal mass infiltrating the serosa and narrowing the lumen.The lesion was composed of endometrial gland structures that were positively stained with CK7 and CD10, indicating deep infiltrating endometrioma.Given the non-specific clinical and imaging features, endometriosis should be considered in the differential diagnosis of colonic obstruction, particularly in women of childbearing age, with or without a history of gynecological surgery.

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