A RARE CASE OF SMALL BOWEL OBSTRUCTION SECONDARY TO ENDOMETRIOSIS AND HYDROSALPINX

Objectives: Small bowel obstructions account for 2-4% of emergency department visits and 15% of hospital admissions, with up to 90% secondary to adhesions from prior abdominal surgery, complex hernias, or neoplasms. Less frequent causes include underlying inflammatory bowel disease, gallstones, volvulus, and intussusception. Obstruction secondary to gynecologic processes such as pelvic inflammatory disease (PID), endometriosis, and tubo-ovarian abscesses is extremely rare, with only a few cases reported in the literature.

We describe the case of a 32-year-old female, without significant past medical or surgical history, who presented to the emergency department (ED) with a three-day history of severe epigastric abdominal pain accompanied by nausea, vomiting, and constipation. Clinical examination revealed a hemodynamically stable patient with a soft but distended abdomen, tenderness in the epigastric region, without signs of peritonitis. Bloodwork, including white blood cell count (WBC), electrolytes, and lactic acid, was unremarkable. Initial computed tomography (CT) scan of the abdomen and pelvis with contrast demonstrated a small bowel obstruction (SBO) with a transition point in the right lower quadrant, accompanied by mesenteric edema and free fluid. Exploratory laparotomy was indicated and revealed a small bowel obstruction secondary to dense adhesions between the terminal ileum, appendix, sigmoid colon, and right ovary. Gynecology was consulted intraoperatively, and it was thought that these adhesions were secondary to PID. Lysis of adhesions, appendectomy, decompression of right hydrosalpinx, and right paratubal cyst excision were performed. The post-operative course was uneventful, and she was ultimately discharged home on 2 weeks of empiric antibiotics for treatment of PID. Surgical pathology showed endometriosis within the appendix and a benign paratubal cyst. She has been seen by both general surgery and gynecology in follow-up visits and is doing well.

This is the first reported case of a small bowel obstruction secondary to adhesions caused by chronic fallopian tube hydrosalpinx and a paratubal cyst, in the setting of both pelvic inflammatory disease and endometriosis. Gynecologic pathologies should be considered in the differential diagnoses in young female patients presenting with SBO, especially in the setting of a virgin abdomen.

Methods:

Results:

Conclusion: