title: Flare-up of endometriosis induced by gonadotropin-releasing hormone agonist leading to bowel obstruction.
abstract: OBJECTIVE
  To report a case of intestinal obstruction that developed shortly after preoperative administration of a GnRH analogue (GnRH-a) that caused flare-up and rapid progression of enteric endometriosis.
  
  
  METHODS
  Case report.
  
  
  METHODS
  University tertiary reproductive endocrinology practice.
  
  
  METHODS
  A 34-year-old nulligravid female with progressive severe symptomatic endometriosis.
  
  
  METHODS
  Planned preoperative administration of GnRH-a for 3 months followed by extirpative surgery and hormone replacement therapy. Instead, total abdominal hysterectomy, bilateral salpingoophorectomy, resection of the obstructed ileocecal junction, and side-to-side ileo-ascending enterocolostomy was performed.
  
  
  RESULTS
  Preoperative GnRH-a administered in the midfollicular phase resulted in flare-up of preexisting ileocecal endometriosis that rapidly progressed, resulting in partial small bowel obstruction.
  
  
  CONCLUSIONS
  Gonadotropin-releasing hormone agonist should be used with caution when there is known or suspected enteric endometriosis. Consideration should be given to blocking the agonistic effect of GnRH-a in this setting by the prior or concomitant use of progestins or danazol.
authors.affiliation: Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA.
authors.forename: L L
authors.initials: LL
authors.lastname: Hall
authors.forename: J M
authors.initials: JM
authors.lastname: Malone
authors.forename: K A
authors.initials: KA
authors.lastname: Ginsburg
mesh_terms: D000328:Adult; D004715:Endometriosis / Q000139:chemically induced* / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007077:Ileal Diseases / Q000209:etiology / Q000601:surgery; D007080:Ileocecal Valve / Q000601:surgery; D007415:Intestinal Obstruction / Q000209:etiology* / Q000601:surgery; D016729:Leuprolide / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D016729:Leuprolide