Perforation of the sigmoid colon during pregnancy: A rare complication of endometriosis

Perforation of the sigmoid colon in a 28-year-old woman during the 35th week of pregnancy is reported. The patient was admitted for crampy lower abdominal pain, and fetal distress observed on cardiotocography led to the decision of an emergency cesarean section. At laparotomy the sigmoid colon was found to be covered by a green, fibropurulent exudate, and a small area of perforation was found. At pathologic examination there was almost complete replacement of the bowel wall by endometriotic tissue, showing extensive decidualization of its stroma. Although obviously rare, perforation of the sigmoid colon due to endometriosis should be considered in the differential diagnosis of an acute condition of the abdomen during pregnancy.