Rectal Obstruction Secondary to Endometriosis with Fibrotic Obliteration of the Cul-de-Sac : An Innovative Surgical Approach

Background: Endometriosis is defined by the presence of endometrial glands and stroma outside the usual location. Rectal involvement is rare. It can mimic malignancy and pose a diagnostic and operative challenge. Case: A 27-year-old woman presented with deep infiltrating endometriosis that appeared to be an acute intestinal obstruction. Rectal resection was not possible due to dense adhesions, and extensive dissection was unwarranted considering this patient's nulliparous status. She underwent a laparotomy for stricture management. She was diagnosed with Stage 4 endometriosis during that procedure. The presacral space was dissected bluntly up to the pelvic diaphragm. The sigmoid colon was divided proximal to the stricture and was anastomosed with the posterior wall of the rectum distal to the stenosed segment, using a circular stapler, an approach known as a Duhamel procedure Results: This patient's recovery was uneventful and she was started on medical management of her endometriosis; this resolved her complaints. Conclusions: In such cases, the Duhamel procedure can be used as a successful alternative to overcome the anal obstruction.