INTRODUCTION: Intestinal endometriosis is often an infrequently considered 
diagnosis in female of childbearing age by general surgeon. There is a delay in 
diagnosis because of constellation of symptoms and lack of specific diagnostic 
modalities. Patients suffer from intestinal endometriosis for many years before 
they are diagnosed. Often, such patients are labelled with irritable bowel 
syndrome. Intestinal endometriosis has a diagnostic time delay of 8-11 years due 
to its non-specific clinical features and multi-system involvement.
PRESENTATION OF CASE: Our patient was a 32 years old Caucasian female who was 
referred to us with features of intestinal obstruction. Despite repeated 
clinical assessments and use of different diagnostic modalities the diagnosis 
was still inconclusive even after 21 days of her first presentation to primary 
care physician. She had an exploratory laparotomy, sigmoid colectomy, and 
Hartmann's procedure with a temporary colostomy with us. Histopathology 
confirmed endometriosis and also showed melanosis coli. She was referred to the 
gynaecological team for review and follow up.
DISCUSSION: Intestinal endometriosis should be considered as a differential 
diagnosis in female patients of childbearing age group presenting with 
non-specific gastrointestinal signs and symptoms. Our patient manifested 
intestinal endometriosis and melanosis coli on histopathology suggesting 
symptoms of long duration.
CONCLUSION: Bowel endometriosis is a less considered and often ignored 
differential diagnosis in acute and chronic abdomen. This condition has 
considerable effect on patient's health both physically and psychologically.