title: Rare manifestation of endometriosis causing complete recto-sigmoid obstruction: A case report.
abstract: BACKGROUND
  Endometriosis is a disease in which endometrial epithelium implanted outside the uterus. Although the endometrial tissue can implant anywhere, the most common places are the ovary and pelvic peritoneum. We present a rare case of recto-sigmoid endometriosis that causes a complete large bowel obstruction in a non-reproductive age woman who came with no specific symptoms of endometriosis and the diagnosis was made after surgical resection.
  
  
  METHODS
  A 50 years old female who never been married and admitted to have no sexual experience in her life, presented with symptoms of acute bowel obstruction. She underwent sigmoid colectomy as the primary diagnosis was colonic tumor, but the histopathological reports showed the diagnosis with recto-sigmoidal Endometriosis. At the second laparotomy for closure of colostomy, the uterus was abnormal and she had a hysterectomy with salpingio-oopherectomy to prevent recurrence. The histopathological report revealed cervical, ovarian, and fallopian tube endometriosis.
  
  
  CONCLUSIONS
  Unlike our patient, most patients complain of the common symptoms of endometriosis such as dysmenorrhea, dyspareunia, and dyschezia and many of them came with infertility as a main complaint which make them undergo further investigations like laparoscopy, and lead to pre-surgical diagnosis of endometriosis. But in case of complete bowel obstruction, urgent laparotomy is the treatment of choice.
  
  
  CONCLUSIONS
  Although Intestinal endometriosis is rare to cause bowel obstruction physicians and surgeons should always consider it as a differential diagnosis of bowel obstruction even without specific symptoms, to prevent surgery in incomplete obstruction.
authors.affiliation: Dept. of Surgery, Damascus Hospital, Damascus, Syria. Electronic address: Shawki1290@gmail.com.
authors.forename: Shawqi
authors.initials: S
authors.lastname: Arafat
authors.affiliation: Dept. of Surgery, Damascus Hospital, Damascus, Syria. Electronic address: drsabekb@gmail.com.
authors.forename: Mhd Belal
authors.initials: MB
authors.lastname: Alsabek
authors.affiliation: Dept. of Surgery, Damascus Hospital, Damascus, Syria. Electronic address: dr.almousa16@gmail.com.
authors.forename: Faisal
authors.initials: F
authors.lastname: Almousa
authors.affiliation: Dept. of Surgery, Faculty of Medicine, Syrian Private University, Damascus, Syria. Electronic address: makubtan@gmail.com.
authors.forename: Muhammad Assem
authors.initials: MA
authors.lastname: Kubtan
keywords: Colon; Complete obstruction; Endometriosis; Fallopian tubes; Rare case; Uterus