Endometriosis: A diagnostic merry-go-round: A case report

This case report describes a 28-year-old nulliparous woman with two years of recurrent colicky right lower quadrant to generalized abdominal pain, weight loss, bowel habit change, and episodes worsened around menses who experienced intestinal obstruction and required three exploratory laparotomies after being misdiagnosed twice in a resource-limited setting (appendicitis/fibroid, then ovarian cyst/fibroid). At the third operation, surgeons found major right-sided pelvic adhesions with an endometrioma involving the right ovary and fallopian tube, entangling the terminal ileum/cecum, and an enlarged left ovary; histology confirmed endometriosis with endometrial glands and stroma. The authors note a key limitation inherent to case-report design and emphasize that lack of diagnostic tools/expertise likely contributed to repeated diagnostic errors. This paper is centrally about endometriosis — specifically a diagnostic “merry-go-round” presentation complicated by intestinal obstruction from an ileal/caecal endometriotic mass and adhesions.

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