Intestinal Perforation due to Deep Infiltrating Endometriosis during Pregnancy: Case Report

Márcia Mendonça Carneiro, Luciana Maria Pyramo Costa, Maria Das Graças Torres, Patrícia Salomé Gouvea, Ivete de Ávila
Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia · 2018 · vol. 40(04) , pp. 235–238 · doi:10.1055/s-0038-1624579 · PMID:29747214 · W2799586330
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This case report describes a pregnancy complicated by intestinal perforation due to deep infiltrating endometriosis, requiring cesarean delivery, colostomy, and subsequent laparoscopic excision of endometriotic lesions.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 ⓘ

This case report describes a 33-year-old woman with long-standing severe dysmenorrhea and endometriosis-related pain who underwent four laparoscopies from 2003–2009 and subsequent medical treatments including GnRH analogues and a levonorgestrel intrauterine system, with persistent symptoms including dyschezia. In 2010, colonoscopy identified rectosigmoid stenosis likely due to extrinsic compression, and she became spontaneously pregnant after LNG-IUS removal; at 33 weeks’ gestation, she developed severe abdominal pain and underwent cesarean delivery where an intestinal rupture was identified, followed by peritoneal infection, sepsis, and colostomy, with recovery after ICU care. Three months later the colostomy was closed, and definitive management after joining a multidisciplinary endometriosis team included diagnostic imaging and laparoscopic excision with segmental colectomy in 2014, after which follow-up ultrasound showed pelvic adhesions but no endometriotic lesions. The paper does not explicitly state a limitation beyond the lack of earlier operative records, and it highlights uncertainty about pre-pregnancy surgical decision-making and the role of colonoscopy in intestinal deep infiltrating endometriosis. This paper is centrally about endometriosis — specifically deep infiltrating intestinal endometriosis complicated by intestinal rupture during pregnancy.

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Abstract

We report the case of a 33 year-old woman who complained of severe dysmenorrhea since menarche. From 2003 to 2009, she underwent 4 laparoscopies for the treatment of pain associated with endometriosis. After all four interventions, the pain recurred despite the use of gonadotropin-releasing hormone (GnRH) analogues and the insertion of a levonorgestrel intrauterine system (LNG-IUS). Finally, a colonoscopy performed in 2010 revealed rectosigmoid stenosis probably due to extrinsic compression. The patient was advised to get pregnant before treating the intestinal lesion. Spontaneous pregnancy occurred soon after LNG-IUS removal in 2011. In the 33rd week of pregnancy, the patient started to feel severe abdominal pain. No fever or sings of pelviperitonitis were present, but as the pain worsened, a cesarean section was performed, with the delivery of a premature healthy male, and an intestinal rupture was identified. Severe peritoneal infection and sepsis ensued. A colostomy was performed, and the patient recovered after eight days in intensive care. Three months later, the colostomy was closed, and a new LNG-IUS was inserted. The patient then came to be treated by our multidisciplinary endometriosis team. The diagnostic evaluation revealed the presence of intestinal lesions with extrinsic compression of the rectum. She then underwent a laparoscopic excision of the endometriotic lesions, including an ovarian endometrioma, adhesiolysis and segmental colectomy in 2014. She is now fully recovered and planning a new pregnancy. A transvaginal ultrasound (TVUS) performed six months after surgery showed signs of pelvic adhesions, but no endometriotic lesions.

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Condition tags

endometriosisdie_deep_infiltratingendometriomadysmenorrhea

MeSH descriptors

Endometriosis Intestinal Diseases Intestinal Perforation Pregnancy Complications Adult Endometriosis Female Humans Intestinal Diseases Intestinal Perforation Pregnancy Pregnancy Complications

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