Intestinal endometriosis complicated by ileal perforation after initiation of gonadotropin-releasing hormone agonist therapy

Objective: To report a rare complication of GnRH agonist therapy for intestinal endometriosis. Design: Case report. Setting: University hospital. Patient(s): A 45-year-old nulliparous Japanese woman with catamenial digestive symptoms. Intervention(s): GnRH agonist therapy. Main Outcome Measure(s): Acute abdomenal crisis with free air in the abdominal X-ray. Result(s): An emergency laparotomy showed both an ileal constriction and perforation. An ileocecal enterectomy with an end-to-end anastomosis was performed. A pathological examination of the ileum revealed ileal endometriosis. Conclusion(s): Flare-up of intestinal endometriosis induced by GnRH agonist has the potential to lead to intestinal perforation. Careful diagnosis and treatment are necessary for cyclic and periodic gastrointestinal manifestation.