Guide to Attribute and Manage Upper GI Symptoms to Endometriosis!

Multifaceted impact of endometriosis on women’s health, emphasizing its association with neuropathic pain, cognitive dysfunction, migraine, mental health disorders, and reduced quality of life. Cognitive impairments, characterized as “brain fog”, involve disrupted brain connectivity, neuroinflammation, and hormonal imbalances, contributing to daily functional challenges. The coexistence of migraine exacerbates disease burden, sharing inflammatory pathways and hormonal sensitivities, yet remains under-treated. Anxiety and depression are prevalent, mediated by neuroinflammatory processes, chronic pain, and psychosocial stressors, significantly impairing mental health and social functioning. Furthermore, endometriosis substantially decreases quality of life across physical, emotional, and social domains, often surpassing other chronic conditions. Gastrointestinal (GI) symptoms in women, such as cyclical abdominal pain, bloating, constipation, diarrhoea, and pain during bowel movements, surprisingly lead frequently to underlying endometriosis. Often misdiagnosed as irritable bowel syndrome (IBS), these GI issues worsen during menstruation due to endometriosis lesions on the bowel, necessitating a holistic approach. Sigmoid colon and rectum are the most common sites for bowel involvement, followed by the ileum and appendix. Most patients present with abdominal pain which intensifies during menstruation, with "endo belly" (bloating), constipation, and diarrhoea alternately. Diagnosis is challenging due to non-specific symptoms, imaging like pelvic ultrasound (USG), CT scan or MRI, or sometime even laparoscopy is crucial for identifying masses or strictures. Material & Methods: Two emergency GI symptoms cases referred in 2025 taught this author the vagaries of endometriosis. First case clinically diagnosed as intestinal obstruction or carcinoma of colon, after a laparotomy, histopathological examination of resected segment of sigmoid colon’s proved it to be a case of endometriosis. The second case with a two-day history of vomiting, abdominal distention and absolute constipation, CT scan abdomen indicating a distal small bowel obstruction close to the terminal ileum. Laparotomy confirmed a small bowel stricture approximately 20 cm from the caecum, macroscopically consistent of endometrial deposits and histopathology confirmed extensive endometriosis. Outcomes: Both patients made an uneventful post-operative recovery and referred to gynaecology department for ongoing management of endometriosis.