Case report: A rare cause of intestinal perforation in a third-trimester pregnant woman

TL;DR

A pregnant woman experienced intestinal perforation due to undiagnosed endometriosis, highlighting the need for awareness of such rare complications during pregnancy.

Contribution

This case report highlights a rare cause of intestinal perforation in pregnancy linked to undiagnosed endometriosis.

Findings

A third-trimester pregnant woman had cecal and appendiceal perforation due to deep infiltrating endometriosis.

Sonography initially suggested acute appendicitis, but the true cause was endometriosis-related ulceration.

The case underscores the importance of considering endometriosis in pregnancy-related abdominal emergencies.

Abstract

An acute abdomen is a medical emergency that requires early diagnosis and treatment. In pregnancy, this process is significantly more challenging, and radiological findings are sometimes unclear due to the enlarged uterus displacing other structures. Moreover, endometriosis-related complications are rare, and the disease is often undiagnosed.

We report a case of acute perforation of the cecum and appendix during pregnancy (35 weeks of gestation) caused by a previously unknown, deep infiltrating endometriosis with focal ulceration of the affected bowel wall, which sonographically seemed to be acute appendicitis.

Despite the relatively low risk, clinicians should be aware of possible endometriosis-associated complications in pregnancy with potentially life-threatening events, even in previously unknown endometriosis. Further studies should evaluate intestinal complications during pregnancy in relation to previous treatment of intestinal endometriosis (conservative vs. surgical).

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