Cecal endometriosis presenting as a term intrauterine fetal demise and gastrointestinal hemorrhage: A case report

BACKGROUND: Of women diagnosed with endometriosis, 3.8–37% have bowel endometriosis. The cecum is the least common site for endometriotic implants affecting the bowel, accounting for only 3.6–6% of cases. We present a case of intrauterine fetal demise at term in which the patient was found to have gastrointestinal bleeding caused by endometriosis of the cecum. CASE: A 35-year-old woman, gravida 4, para 1, at 37 weeks and 3 days of gestation, without a known history of endometriosis but with two prior miscarriages, presented with severe anemia and intrauterine fetal demise. During delivery, melanotic stool was noted. Colonoscopic biopsy noted the source of bleeding to be a 2 cm endometriotic implant in the patient's cecum. Suppression therapy was started. Postpartum, the patient underwent laparoscopic cecectomy and pathology confirmed the diagnosis of endometriosis. CONCLUSION: Hemorrhage from endometriotic implants may occur during pregnancy due to changes in the hormonal milieu. Bowel endometriosis may increase the risk of maternal hemorrhage during pregnancy, thereby increasing the risk of unfavorable pregnancy outcomes, including intrauterine fetal demise.