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

Objective: To report a case of intestinal obstruction that developed s hortly after preoperative administration of a GnRH analogue (GnRH-a) t hat caused flare-up and rapid progression of enteric endometriosis. De sign: Case report. Setting: University tertiary reproductive endocrino logy practice. Patient: A 34-year-old nulligravid female with progress ive severe symptomatic endometriosis. Interventions: Planned preoperat ive administration of GnRH-a for 3 months followed by extirpative surg ery and hormone replacement therapy. Instead, total abdominal hysterec tomy, bilateral salpingoophorectomy, resection of the obstructed ileoc ecal junction, and side-to-side ileo-ascending enterocolostomy was per formed. Main Outcome Measure: Resolution of symptoms. Results: Preoper ative GnRH-a administered in the midfollicular phase resulted in flare -up of preexisting ileocecal endometriosis that rapidly progressed, re sulting in partial small bowel obstruction. Conclusion: Gonadotropin-r eleasing hormone agonist should be used with caution when there is kno wn or suspected enteric endometriosis. Consideration should be given t o blocking the agonistic effect-of GnRH-a in this setting by the prior or concomitant use of progestins or danazol.