Deep Endometriosis Induced Spontaneous Colon Rectal Perforation in Pregnancy: Laparoscopy Is Advanced Tool to Confirm Diagnosis

Aurelio Costa,Annalisa Sartini,Silvia Garibaldi,Marco Cencini

doi:10.1155/2014/907150

Abstract

Endometriosis causes rare complications in pregnancy, such as obstetrical bleeding, preterm birth, spontaneous haemoperitoneum, and intestinal perforation. The prevalence of spontaneous perforation due to intestinal endometriosis is unknown in pregnancy. A recent review of the literature indicated 15 bowel complications caused by endometriosis during pregnancy or at the immediate postpartum period. The diagnosis of a bowel perforation can be difficult and in all of the cases reported necessitates an exploratory laparotomy. Anyway, in the majority of cases bowel perforation is not diagnosed during this laparotomy, and a repeat laparotomy is needed. Laparoscopy is being used increasingly in the diagnosis and operative management of acute abdomen. Laparoscopy can be a useful means of diagnosis and in addition a therapeutic tool in selected pregnant patients with abdominal pain. We report the first case of a pregnant woman with spontaneous double sigmoid and rectal perforation from decidualized endometriosis diagnosed by laparoscopy.

Highlights

Endometriosis is characterized by benign proliferation of ectopic endometrial glands and stroma in the peritoneal cavity, resulting in inflammation and scarring, often leading to pelvic pain and infertility [1]
We report the case of a pregnant woman with spontaneous double sigmoid and rectal perforation from decidualized endometriosis diagnosed by laparoscopy
Explorative laparoscopy was useful to confirm the clinical suspicion and revealed diffuse severe purulent peritonitis that originated from a double rectal and sigmoid perforation

Summary

Background

Endometriosis is characterized by benign proliferation of ectopic endometrial glands and stroma in the peritoneal cavity, resulting in inflammation and scarring, often leading to pelvic pain and infertility [1]. It affects 2%–10% of women of reproductive age [2]. We report the case of a pregnant woman with spontaneous double sigmoid and rectal perforation from decidualized endometriosis diagnosed by laparoscopy. It shows the possibility of surgical treatment without cesarean delivery at that time

Case Presentation

Discussion