DOI: https://doi.org/10.36347/sjmcr.2026.v14i05.051

Pages: 1084-1087

Bowel endometriosis is an underrecognized extra-pelvic manifestation of endometriosis that poses significant diagnostic challenges due to its clinical overlap with inflammatory bowel diseases and other gastrointestinal disorders. We report the case of a 38-year-old woman with a five-year history of chronic dysmenorrhea who presented with right iliac fossa pain, an intermittent bowel habit disturbance, and a palpable abdominal mass. Laboratory investigations revealed a mildly elevated C-reactive protein (18 mg/L), while ileocolonoscopy demonstrated a completely normal mucosa. Magnetic resonance enterography (MRE) was instrumental in establishing the diagnosis, revealing an irregular thickening of the broad ligament with agglutinated ileal loops forming a pseudo-mass of 47 × 38 mm, associated with post-stenotic bowel dilatation and ipsilateral ovarian traction. Following multidisciplinary discussion and in accordance with the patient's preference for conservative management, hormonal therapy was initiated, resulting in favorable clinical improvement. This case underscores the critical role of advanced cross-sectional imaging when endoscopic findings are non-contributory and highlights the value of a patient-centered, multidisciplinary approach in managing bowel endometriosis.