FLARE-UP OF ENDOMETRIOSIS INDUCED BY GONADOTROPIN-RELEASING-HORMONE AGONIST LEADING TO BOWEL OBSTRUCTION

Objective: To report a case of intestinal obstruction that developed shortly after preoperative administration of a GnRH analogue (GnRH-a) that caused flare-up and rapid progression of enteric endometriosis. Design: Case report. Setting: University tertiary reproductive endocrinology practice. Patient: A 34-year-old nulligravid female with progressive severe symptomatic endometriosis. Interventions: Planned preoperative administration of GnRH-a for 3 months followed by extirpative surgery and hormone replacement therapy. Instead, total abdominal hysterectomy, bilateral salpingoophorectomy, resection of the obstructed ileocecal junction, and side-to-side ileo-ascending enterocolostomy was performed. Main Outcome Measure: Resolution of symptoms. Results: Preoperative GnRH-a administered in the midfollicular phase resulted in flare-up of preexisting ileocecal endometriosis that rapidly progressed, resulting in partial small bowel obstruction. Conclusion: Gonadotropin-releasing hormone agonist should be used with caution when there is known or suspected enteric endometriosis. Consideration should be given to blocking the agonistic effect-of GnRH-a in this setting by the prior or concomitant use of progestins or danazol.