A Diagnostic Conundrum - Small bowel obstruction from undiagnosed endometriosis following uterine perforation

INTRODUCTION: Uterine perforation is a rare but recognized complication from dilation and curettage, a common therapeutic procedure for obstetric complications and emergencies. Limited cases exist on endometriosis occurring following rupture. Additionally, there are no reported cases of uterine rupture secondary to dilation and curettage leading to new onset endometriosis first presenting as a small bowel obstruction (SBO). PRESENTATION OF CASE: A 42-year-old female with recurrent small bowel obstruction was found to have a stricture caused by endometriosis via diagnostic laparoscopy and pathology. Patient had a dilation and curettage for retained products of conception 11 years prior, complicated by uterine perforation. This patient never had a diagnosis of endometriosis prior to her SBO. Patient made an uneventful recovery after small bowel resection with resolving of SBO symptoms. DISCUSSION: Our case highlights the possibility of endometriosis due to previous uterine rupture as a cause for SBO in an otherwise healthy, female patient of reproductive age. There is a continued need for appropriate documentation of surgical complications on patient charts as well as considering postoperative complications when other etiologies of SBO are less likely. CONCLUSION: Endometriosis should be considered as a differential in reproductive aged women presenting with a small bowel obstruction, with an increased index of suspicion if the patient has had previous obstetric surgical procedures.