The Scar-y Side of Endometriosis Resection: Small Bowel Obstruction by Postoperative Scar Tissue

Abstract

A 38-year-old nulligravid female with a long-standing history of severe endometriosis requiring 4 previous excisional procedures, including ileocecal resection and reanastomosis, developed severe epigastric and right upper quadrant pain without an inciting incident. The abdominal upright film revealed multiple dilated small bowel loops with air/fluid levels. Conservative management with bowel decompression was initiated. A computed tomography scan 2 days later demonstrated dilated loops of small bowel consistent with a small bowel obstruction with a transition point at the ileocecal junction near the anastomotic line from her previous resection. The patient was taken to the operating room for diagnostic laparoscopy. A hand-assisted enterolysis was performed, and a stricture of the small bowel was discovered to be a dense band of scar tissue (Fig. 1, Fig. 2). The surrounding bowel was noted to be ischemic. A wedge resection of the distal ileum with a primary suture closure was required to alleviate this stricture. Her prior anastomosis was found to be widely patent. The surgical pathology revealed the band to be scar tissue with ischemic changes and intramural hemorrhage but no evidence of endometriosis. Fig. 2Mesenteric view of constricted segment of ileum with fibrotic band of scar tissue visible between black arrows. View Large Image Figure Viewer Download Hi-res image