Intestinal endometriosis complicated by ileal perforation after initiation of gonadotropin-releasing hormone agonist therapy

OBJECTIVE: To report a rare complication of GnRH agonist therapy for intestinal endometriosis. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A 45-year-old nulliparous Japanese woman with catamenial digestive symptoms. INTERVENTION(S): GnRH agonist therapy. MAIN OUTCOME MEASURE(S): Acute abdomenal crisis with free air in the abdominal X-ray. RESULT(S): An emergency laparotomy showed both an ileal constriction and perforation. An ileocecal enterectomy with an end-to-end anastomosis was performed. A pathological examination of the ileum revealed ileal endometriosis. CONCLUSION(S): Flare-up of intestinal endometriosis induced by GnRH agonist has the potential to lead to intestinal perforation. Careful diagnosis and treatment are necessary for cyclic and periodic gastrointestinal manifestation.