Al Ayoubi Omar, Aldakak Mohammad Alaa, Alabdullah Nizar, Alabdullah Faten, Alasfar Ayman
Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic.
Al-Assad University Hospital, Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic.
Int J Surg Case Rep. 2025 Oct;135:111927. doi: 10.1016/j.ijscr.2025.111927. Epub 2025 Sep 10.
Large bowel obstruction (LBO) is most commonly caused by neoplasms, but rare etiologies like endometriosis should be considered, as bowel involvement can mimic other gastrointestinal disorders and lead to obstruction. Sigmoid endometriosis is a rare but important cause of LBO, which can lead to symptoms ranging from subtle gastrointestinal complaints to overt obstruction. Laparoscopy is the primary diagnostic tool, and surgery is often part of the treatment when obstruction occurs.
We report the case of a 51-year-old Arab female with a history of ulcerative colitis and chronic abdominal symptoms, who presented with progressive distension and intermittent constipation. Colonoscopy revealed a non-passable sigmoid stricture. Surgical resection was performed, and histopathology showed benign endometrial tissue in the colonic wall, confirming sigmoid endometriosis.
Endometriosis is a chronic inflammatory condition that can involve various intraperitoneal and extraperitoneal sites, with intestinal involvement reported in up to 37 % of cases-most commonly in the rectum and sigmoid colon. Gastrointestinal symptoms are often nonspecific and may mimic irritable bowel syndrome, making diagnosis challenging. Imaging modalities often lack specificity, while laparoscopy remains the gold standard. In this case, the diagnosis was only confirmed after surgical resection and histopathological analysis. Although medical therapy can be effective in symptom control, surgical excision becomes necessary when obstructive symptoms are present, as seen in our patient.
This case underscores sigmoid colon endometriosis as an uncommon yet significant cause of large bowel obstruction. Awareness of such rare presentations is essential for timely diagnosis and management.
大肠梗阻（LBO）最常见的病因是肿瘤，但应考虑像子宫内膜异位症这样的罕见病因，因为肠道受累可能会模仿其他胃肠道疾病并导致梗阻。乙状结肠子宫内膜异位症是LBO的一种罕见但重要的病因，可导致从轻微胃肠道不适到明显梗阻的各种症状。腹腔镜检查是主要的诊断工具，当发生梗阻时手术通常是治疗的一部分。
我们报告一例51岁的阿拉伯女性，有溃疡性结肠炎病史和慢性腹部症状，出现进行性腹胀和间歇性便秘。结肠镜检查发现乙状结肠狭窄无法通过。进行了手术切除，组织病理学显示结肠壁有良性子宫内膜组织，证实为乙状结肠子宫内膜异位症。
子宫内膜异位症是一种慢性炎症性疾病，可累及各种腹腔内和腹腔外部位，据报道高达37%的病例有肠道受累，最常见于直肠和乙状结肠。胃肠道症状通常不具有特异性，可能会模仿肠易激综合征，这使得诊断具有挑战性。影像学检查往往缺乏特异性，而腹腔镜检查仍然是金标准。在本病例中，仅在手术切除和组织病理学分析后才确诊。虽然药物治疗在控制症状方面可能有效，但当出现梗阻症状时，如我们的患者所示，手术切除就变得必要。
本病例强调乙状结肠子宫内膜异位症是大肠梗阻的一种罕见但重要的病因。认识到这种罕见表现对于及时诊断和管理至关重要。
