Obstrucción intestinal aguda baja secundaria a endometriosis intestinal. Presentación de caso

Nicolle Dayana Becerra-Páez, Duban Samir Hernández-Rodríguez, Andrés Mauricio Guerrero-Torres, Catalina Arenas-García, Diana Morales
In: Revista Médicas UIS · 2026 · vol. 39(3) , pp. 141 · doi:10.18273/revmed.v39n3-20260013 · W7223403534
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Two women with acute low intestinal obstruction underwent urgent surgery, where histopathology confirmed intestinal endometriosis rather than malignancy, highlighting the need to consider this condition in differential diagnoses for reproductive-age women.

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This case report describes two women aged 43 and 45 who presented with acute lower intestinal obstruction requiring urgent surgical intervention due to suspected malignancy. Imaging revealed stenosing colorectal lesions, and definitive diagnosis was achieved through histopathological and immunohistochemical analysis of the resected specimens, which confirmed intestinal endometriosis. Following surgery, both patients received hormonal treatment and multidisciplinary follow-up, resulting in favorable outcomes with no recurrence observed over a six-month period. The paper highlights that intestinal endometriosis should be included in the differential diagnosis for acute bowel obstruction in reproductive-age women, emphasizing the necessity of histopathology for confirmation. This paper is centrally about endometriosis — specifically the presentation of intestinal endometriosis as a cause of acute lower bowel obstruction mimicking colorectal cancer.

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Abstract

La obstrucción intestinal aguda secundaria a endometriosis intestinal es una complicación infrecuente con una prevalencia estimada entre 0,1 y 0,7 % y representa un importante reto diagnóstico por su capacidad para simular cáncer colorrectal. En el presente reporte se describen dos casos de mujeres de 43 y 45 años que presentaron obstrucción intestinal aguda baja y requirieron manejo quirúrgico urgente ante la sospecha de neoplasia maligna. En ambos casos, los estudios de imagen evidenciaron lesiones colorrectales estenosantes y el diagnóstico definitivo se estableció mediante el estudio histopatológico e inmunohistoquímico de las piezas quirúrgicas que confirmó endometriosis intestinal. Posteriormente, las pacientes recibieron tratamiento hormonal y seguimiento multidisciplinario con evolución favorable y ausencia de recurrencia durante seis meses. Estos casos resaltan que la endometriosis intestinal debe considerarse en el diagnóstico diferencial de la obstrucción intestinal aguda baja en mujeres en edad reproductiva y que la histopatología continúa siendo el método definitivo para confirmar el diagnóstico y orientar el manejo.
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Resumen La obstrucción intestinal aguda secundaria a endometriosis intestinal es una complicación infrecuente con una prevalencia estimada entre 0,1 y 0,7 % y representa un importante reto diagnóstico por su capacidad para simular cáncer colorrectal. En el presente reporte se describen dos casos de mujeres de 43 y 45 años que presentaron obstrucción intestinal aguda baja y requirieron manejo quirúrgico urgente ante la sospecha de neoplasia maligna. En ambos casos, los estudios de imagen evidenciaron lesiones colorrectales estenosantes y el diagnóstico definitivo se estableció mediante el estudio histopatológico e inmunohistoquímico de las piezas quirúrgicas que confirmó endometriosis intestinal. Posteriormente, las pacientes recibieron tratamiento hormonal y seguimiento multidisciplinario con evolución favorable y ausencia de recurrencia durante seis meses. Estos casos resaltan que la endometriosis intestinal debe considerarse en el diagnóstico diferencial de la obstrucción intestinal aguda baja en mujeres en edad reproductiva y que la histopatología continúa siendo el método definitivo para confirmar el diagnóstico y orientar el manejo. Citas 1. Taylor HS, Kotlyar AM, Flores VA. Endometriosis is a chronic systemic disease: clinical challenges and novel innovations. Lancet. 2021;397(10276):839-852. 2. Xu S, Zhang Y, Ye P, Huang Q, Wang Y, Zhang Y, et al. Global, regional, and national burden of endometriosis among women of childbearing age from 1990 to 2021: a cross-sectional analysis from the 2021 global burden of disease study. Int J Surg. 2025;111(9):5927-5940. 3. Espitia F. Disfunciones sexuales en las mujeres con endometriosis. Estudio de prevalencia. Rev Chil Obstet Ginecol. 2024;89(3):139-145. 4. Habib N, Centini G, Lazzeri L, Amoruso N, El Khoury L, Zupi E, et al. Bowel endometriosis: current perspectives on diagnosis and treatment. Int J Womens Health. 2020;12:35-47. 5. Ferrero S, Stabilini C, Barra F, Clarizia R, Roviglione G, Ceccaroni M. Bowel resection for intestinal endometriosis. Best Pract Res Clin Obstet Gynaecol. 2021;71:114-128. 6. Gurluler E, Isik O, Ugras N, Sahin A, Sen M, Yilmazlar T. Intestinal endometriosis amongst other extra-pelvic endometriosis foci presenting as acute/subacute bowel obstruction in women of reproductive age: a retrospective case series study. BMC Surg. 2025 ;25(1):12. 7. Nezhat C, Li A, Falik R, Copeland D, Razavi G, Shakib A, et al. Bowel endometriosis: diagnosis and management. Am J Obstet Gynecol. 2018;218(6):549-562. 8. Guerriero S, Saba L, Pascual M, Ajossa S, Rodriguez I, Mais V, et al. Transvaginal ultrasound vs magnetic resonance imaging for diagnosing deep infiltrating endometriosis: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2018;51(5):586-595. 9. As-Sanie S, Mackenzie SC, Morrison L, Schrepf A, Zondervan KT, Horne AW, et al. Endometriosis: A Review. JAMA. 2025;334(1):64-78. 10. D'Alterio MN, D'Ancona G, Raslan M, Tinelli R, Daniilidis A, Angioni S. Management Challenges of Deep Infiltrating Endometriosis. Int J Fertil Steril. 2021;15(2):88-94. 11. Yela DA, Vitale SG, Vizotto MP, Benetti-Pinto CL. Risk factors for recurrence of deep infiltrating endometriosis after surgical treatment. J Obstet Gynaecol Res. 2021;47(8):2713-2719. 12. Scioscia M, Orlandi S, Trivella G, Portuese A, Bettocchi S, Pontrelli G, et al. Sonographic differential diagnosis in deep infiltrating endometriosis: The Bowel. Biomed Res Int. 2019:5958402. 13. Ioutas G, Tsoulfas G. Management of large bowel obstruction. En: Nigri G, Tsoulfas G, editores. Gastrointestinal surgical emergencies. American College of Surgeons International Relations Committee; 2021 [citado 27 sep 2026]. Disponible en: https://www.facs.org/media/o1gazfwy/2021_ms_gisemanual_final_01_22.pdf 14. Naveed M, Jamil LH, Fujii-Lau LL, Al-Haddad M, Buxbaum JL, Fishman DS, Jue TL et al. American society for gastrointestinal endoscopy guideline on the role of endoscopy in the management of acute colonic pseudo-obstruction and colonic volvulus. Gastrointest Endosc. 2020;91(2):228-235. 15. Miller G, Sokolova A, Bettington M, Rosty C, Brown I. Colorectal endometriosis-a challenging, often overlooked cause of colorectal pathology: a clinicopathological review of 114 cases. Pathology. 2024;56(6):795-803. 16. Stevens K, Wasfie T, Haus C. Endometrioma Causing Near-Complete Obstruction of the Sigmoid Colon. Am Surg. 2023;89(4):1264-1266. 17. Sassi S, Bouassida M, Touinsi H, Mongi Mighri M, Baccari S, Chebbi F, et al. Exceptional cause of bowel obstruction: rectal endometriosis mimicking carcinoma of rectum: a case report. Pan Afr Med J. 2011;10:33. 18. Wu C, Wei M, Yeung J, Battye S, Cho J. Deep infiltrating endometriosis mimicking colorectal cancer. ANZ J Surg. 2023;93(11):2751-2753. 19. Mota LM, Hirsch BS, Seligman R. Large Bowel Endometriosis Mimicking Colorectal Cancer. Case Rep. Med. 2020:7014107. 20. Aldhaheri S, Suarthana E, Capmas P, Badeghiesh A, Gil Y, Tulandi T. Association Between Bowel Obstruction or Intussusception and Endometriosis. J Obstet Gynaecol Can. 2021 ;43(4):440-446. 21. Mușat F, Păduraru DN, Bolocan A, Constantinescu A, Ion D, Andronic O. Endometriosis as an Uncommon Cause of Intestinal Obstruction-A Comprehensive Literature Review. J Clin Med. 2023 6;12(19):6376. 22. Nasim H, Sikafi D, Nasr A. Sigmoid endometriosis and a diagnostic dilemma – A case report and literature review. Int J Surg Case Rep. 2011;2(7):181-4. 23. Zhao LJ, Wang YH, Zhang JD. A case report: Rectal endometriosis mimicking rectal cancer. Int J Surg Case Rep. 2018;53:137-139. 24. Rajan R, Clark D. Current management of large bowel obstruction: a narrative review. Ann Laparosc Endosc Surg. 2022;7(23):21-45 25. Kishore KA, Jadhav KP, Jeughale KB, Chavan MT, Deshmukh AB, Pinjari R. A comparative study between primary resection anastomosis versus Hartmann’s procedure with colostomy in patients of colonic mass presenting with acute intestinal obstruction. Int J Res Med Sci. 2025;13(9):3692-3697. 26. Vercellini P, Sergenti G, Buggio L, Frattaruolo MP, Dridi D, Berlanda N. Advances in the medical management of bowel endometriosis. Best Pract Res Clin Obstet Gynaecol. 2021; 71:78-99. 27. Bandini V, Giola F, Ambruoso D, Cipriani S, Chiaffarino F, Vercellini P. The natural evolution of untreated deep endometriosis and the effect of hormonal suppression: A systematic literature review and meta-analysis. Acta Obstet Gynecol Scand. 2024;103(9):1722-1735. Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0. Derechos de autor 2026 Médicas UIS

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