Rare manifestation of endometriosis-related intestinal obstruction in the small bowel of a middle-aged female: a case report

Introduction: Endometriosis, the implantation and proliferation of endometrial tissue outside the uterus, is a chronic inflammatory disease affecting 6–10% of menstruating women. While ovarian involvement is the most common, intestinal endometriosis accounts for 3–37% of cases of women diagnosed with endometriosis, with distal ileal endometriosis (DIE) causing bowel obstruction being particularly rare. Case presentation: A 43-year-old Syrian woman with a history of infertility presented with generalized abdominal pain, vomiting, and fever. Imaging studies revealed dilated intestinal loops and air-fluid levels. Surgical exploration identified an edematous, volvulated segment of the terminal ileum causing small bowel obstruction. Microscopic examination of the resected segment confirmed the diagnosis of ileal endometriosis, showing endometrial glands and stroma within the intestinal wall. Discussion: Intestinal endometriosis is typically seen in the rectosigmoid colon but rarely affects the small intestine, with the ileum being an uncommon site. Symptoms of DIE often mimic other gastrointestinal disorders, making the diagnosis difficult. Surgical approach remains the gold standard for confirming the diagnosis and management when obstruction occurs. Conclusion: This case underscores the importance of considering intestinal endometriosis in the differential diagnosis of chronic or acute abdominal pain and bowel obstruction, especially in women of reproductive age with a history of infertility.