Flare-up of endometriosis induced by gonadotropin-releasing hormone agonist leading to bowel obstruction.
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.
Hall
L L
LL
Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA.
Malone
J M
JM
Ginsburg
K A
KA
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
D016729:Leuprolide