Experience with Laparoscopic Surgery for Rectal Obstruction Caused by Intestinal Endometriosis with a Frozen Pelvis: A Case Report

INTRODUCTION: While intestinal obstruction is common, intestinal endometriosis is relatively rare, making its etiology still poorly understood. We report a case of rectal obstruction caused by intestinal endometriosis with a frozen pelvis, treated with laparoscopy in collaboration with gynecologists. CASE PRESENTATION: A 39-year-old female patient was diagnosed with rectal obstruction resulting from endometriosis with a frozen pelvis by her previous physician and subsequently treated with a transverse colon stoma for rectal obstruction and hormonal therapy for endometriosis. Unfortunately, her condition did not improve after hormonal therapy at our hospital; hence, laparoscopic low anterior resection and pelvic unclogging were performed. Regarding the extent of intestinal dissection, the rectal dissection was performed by dissecting to the point where no tissue changes were observed on the serosal side. Pathological findings revealed endometrial gland-like ducts and intimal stromal hyperplasia spanning from the serosa to the submucosa of the rectum. Her postoperative course was uneventful, leading to her discharge on postoperative day 15. The stoma was closed postoperatively, and gastrointestinal symptoms such as bowel obstruction and bleeding did not recur. CONCLUSIONS: The extent of intestinal endometriosis preoperatively is difficult to determine accurately. Identifying the extent of bowel resection has a significant impact on the patient's postoperative activities of daily living. Thus, carefully observing the lesion intraoperatively and resecting it at a sufficient distance from the occluding lesion are advisable.