Deep-Infiltrating Endometriosis Causing Acute Mechanical Intestinal Obstruction Without Intestinal Invasion: A Case Report with Diagnostic and Surgical Insights

BACKGROUND: Endometriosis is a chronic, estrogen-dependent disorder that may extend beyond the pelvis to involve the gastrointestinal tract, most commonly the rectosigmoid and, less frequently, the small bowel. Although often asymptomatic, such lesions may rarely manifest as acute bowel obstruction. CASE: We report a 42-year-old woman who presented with small bowel ileus caused by deep-infiltrating endometriosis (DIE). Imaging revealed a right ovarian endometrioma with severe adhesions resulting in a distal ileal transition point. After partial decompression with conservative treatment, laparoscopic adhesiolysis with right salpingo-oophorectomy and left salpingectomy was undertaken. Intraoperative findings revealed dense adnexal-ileal adhesions without transmural involvement. Postoperative hormonal suppression was instituted. CONCLUSIONS: This rare case demonstrates small bowel obstruction caused by DIE adhesions without intestinal invasion. Preoperative imaging facilitated a minimally invasive approach, while combined surgical and hormonal therapy was associated with reduced recurrence risk. These findings expand the recognized spectrum of endometriosis-related intestinal complications and support tailored management strategies.