{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T07:00:09Z","timestamp":1789196409008,"version":"build-2803163510"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,7,3]],"date-time":"2024-07-03T00:00:00Z","timestamp":1719964800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>An acute abdomen is a medical emergency that requires early diagnosis and treatment. In pregnancy, this process is significantly more challenging, and radiological findings are sometimes unclear due to the enlarged uterus displacing other structures. Moreover, endometriosis-related complications are rare, and the disease is often undiagnosed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case presentation<\/jats:title><jats:p>We report a case of acute perforation of the cecum and appendix during pregnancy (35\u2009weeks of gestation) caused by a previously unknown, deep infiltrating endometriosis with focal ulceration of the affected bowel wall, which sonographically seemed to be acute appendicitis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Despite the relatively low risk, clinicians should be aware of possible endometriosis-associated complications in pregnancy with potentially life-threatening events, even in previously unknown endometriosis. Further studies should evaluate intestinal complications during pregnancy in relation to previous treatment of intestinal endometriosis (conservative vs. surgical).<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2024.1387043","type":"journal-article","created":{"date-parts":[[2024,7,3]],"date-time":"2024-07-03T04:39:55Z","timestamp":1719981595000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case report: A rare cause of intestinal perforation in a third-trimester pregnant woman"],"prefix":"10.3389","volume":"11","author":[{"given":"Clemens","family":"Stiegler","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Kapitza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Weber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wladimir","family":"Patalakh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claus","family":"Sch\u00e4fer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,7,3]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1016\/j.ejogrb.2011.09.041","article-title":"Prevalence and incidence of diagnosed endometriosis and risk of endometriosis in patients with endometriosis-related symptoms: findings from a statutory health insurance-based cohort in Germany","volume":"160","author":"Abbas","year":"2012","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"3412","DOI":"10.1093\/humrep\/des316","article-title":"Diagnostic delay for endometriosis in Austria and Germany: causes and possible consequences","volume":"27","author":"Hudelist","year":"2012","journal-title":"Hum Reprod"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"3707","DOI":"10.3748\/wjg.v19.i23.3707","article-title":"Ileocecal endometriosis and a diagnosis dilemma: a case report and literature review","volume":"19","author":"Tong","year":"2013","journal-title":"World J Gastroenterol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1055\/a-0824-6952","article-title":"EFSUMB position paper: recommendations for gastrointestinal ultrasound (GIUS) in acute appendicitis and diverticulitis","volume":"40","author":"Dirks","year":"2019","journal-title":"Ultraschall Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1007\/s00261-016-0862-0","article-title":"The role of preoperative graded compression ultrasound in detecting acute appendicitis and influencing the negative appendectomy rate","volume":"42","author":"Shirah","year":"2017","journal-title":"Abdom Radiol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"888","DOI":"10.1007\/s00104-023-01963-1","article-title":"S1 guideline \u201crecommendations for the treatment of acute appendicitis in adults\u201d","volume":"94","author":"Croner","year":"2023","journal-title":"Chirurgie (Heidelberg, Germany)"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"839","DOI":"10.1016\/S0140-6736(21)00389-5","article-title":"Endometriosis is a chronic systemic disease: clinical challenges and novel innovations","volume":"397","author":"Taylor","year":"2021","journal-title":"Lancet (London, England)"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2018\/3461209","article-title":"Gastrointestinal and urinary tract endometriosis: a review on the commonest locations of Extrapelvic endometriosis","volume":"2018","author":"Charatsi","year":"2018","journal-title":"Adv Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"526","DOI":"10.1177\/1933719116672587","article-title":"Bone marrow stem cell chemotactic activity is induced by elevated CXCl12 in endometriosis","volume":"24","author":"Moridi","year":"2017","journal-title":"Reproduct Sci"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1016\/j.scr.2015.04.004","article-title":"Chemoattraction of bone marrow-derived stem cells towards human endometrial stromal cells is mediated by estradiol regulated CXCL12 and CXCR4 expression","volume":"15","author":"Wang","year":"2015","journal-title":"Stem Cell Res"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2019\/7024172","article-title":"Endometriosis mimicking a cecum mass with complete bowel obstruction: an infrequent cause of acute abdomen","volume":"2019","author":"Molina","year":"2019","journal-title":"Case Rep Surg"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1147","DOI":"10.1007\/s00384-019-03242-0","article-title":"Appendiceal endometriosis invading the sigmoid colon: a rare entity","volume":"34","author":"Lainas","year":"2019","journal-title":"Int J Color Dis"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"197","DOI":"10.14309\/ajg.0000000000001981","article-title":"Endometriosis of the appendix, cecum, and ileum masquerading as suspected Crohn's disease","volume":"118","author":"Cho","year":"2023","journal-title":"Am J Gastroenterol"},{"key":"ref14","first-page":"12","article-title":"Caso clinico e revisione della letteratura","volume":"21","author":"la Greca","year":"2000","journal-title":"G Chir"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"719","DOI":"10.1159\/000530896","article-title":"High frequency of deep infiltrating endometriosis in patients with inflammatory bowel disease: a nested case-control study","volume":"41","author":"Neri","year":"2023","journal-title":"Digest Dis"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1097\/OGX.0000000000001107","article-title":"Spontaneous Hemoperitoneum in pregnancy and endometriosis: a new challenge in a known disease","volume":"78","author":"Zilberman Sharon","year":"2023","journal-title":"Obstet Gynecol Surv"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"744","DOI":"10.1111\/jog.15498","article-title":"Endometriosis-related spontaneous hemoperitoneum in pregnancy: a case series","volume":"49","author":"Bazzurini","year":"2023","journal-title":"J Obstet Gynaecol Res"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1007\/s10140-019-01747-3","article-title":"Emergent MRI for acute abdominal pain in pregnancy-review of common pathology and imaging appearance","volume":"27","author":"Ali","year":"2020","journal-title":"Emerg Radiol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"578","DOI":"10.1111\/acem.13169","article-title":"Diagnostic value and effect of bedside ultrasound in acute appendicitis in the emergency department","volume":"24","author":"Gungor","year":"2017","journal-title":"Acad Emerg Med"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1111\/acem.12631","article-title":"Properties of serial ultrasound clinical diagnostic pathway in suspected appendicitis and related computed tomography use","volume":"22","author":"Schuh","year":"2015","journal-title":"Acad Emerg Med"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"749","DOI":"10.1016\/j.jacr.2011.07.010","article-title":"ACR appropriateness criteria\u00ae right lower quadrant pain--suspected appendicitis","volume":"8","author":"Rosen","year":"2011","journal-title":"J Am Coll Radiol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"8107","DOI":"10.1080\/14767058.2021.1961730","article-title":"Acute appendicitis and pregnancy: diagnostic performance of magnetic resonance imaging","volume":"35","author":"Badr","year":"2022","journal-title":"J Matern Fetal Neonatal Med"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1007\/s13244-016-0469-6","article-title":"How to diagnose acute appendicitis: ultrasound first","volume":"7","author":"Mostbeck","year":"2016","journal-title":"Insights Imaging"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1002\/jmri.21456","article-title":"MRI vs. ultrasound for suspected appendicitis during pregnancy","volume":"28","author":"Israel","year":"2008","journal-title":"J Magn Reson Imaging"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"3929","DOI":"10.1080\/14767058.2019.1592154","article-title":"The diagnostic accuracy of ultrasound in the diagnosis of acute appendicitis in pregnancy","volume":"33","author":"Baruch","year":"2020","journal-title":"J Matern Fetal Neonatal Med"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"CD012028","DOI":"10.1002\/14651858.CD012028.pub2","article-title":"Magnetic resonance imaging (MRI) for diagnosis of acute appendicitis","volume":"2021","author":"D'Souza","year":"2021","journal-title":"Cochrane Database Syst Rev"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1641","DOI":"10.2169\/internalmedicine.5960-20","article-title":"Deciduosis of the appendix during pregnancy","volume":"60","author":"Tsunemitsu","year":"2021","journal-title":"Int Med"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1136\/bcr-2022-251610","article-title":"Caecal endometriosis presenting with an acute abdomen in pregnancy","volume":"15","author":"Dunphy","year":"2022","journal-title":"BMJ Case Rep"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1016\/j.fertnstert.2013.11.001","article-title":"Bowel complications of deep endometriosis during pregnancy or in vitro fertilization","volume":"101","author":"Set\u00fabal","year":"2014","journal-title":"Fertil Steril"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"647","DOI":"10.1186\/s12884-022-04973-9","article-title":"Acute endometriosis-related sigmoid perforation in pregnancy-case report","volume":"22","author":"Mittelstadt","year":"2022","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"826","DOI":"10.1016\/j.fertnstert.2022.12.042","article-title":"Endometriosis is associated with pregnancy loss: a nationwide historical cohort study","volume":"119","author":"Boje","year":"2023","journal-title":"Fertil Steril"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1097\/AOG.0000000000003410","article-title":"Endometriosis and risk of adverse pregnancy outcomes","volume":"134","author":"Farland","year":"2019","journal-title":"Obstet Gynecol"},{"key":"ref33","first-page":"61","article-title":"Endometriosis in pregnancy\u2014diagnostics and management","volume":"84","author":"Fr\u00fchauf","year":"2019","journal-title":"Ceska Gynekologie"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2024.1387043\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,3]],"date-time":"2024-07-03T04:40:03Z","timestamp":1719981603000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2024.1387043\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,3]]},"references-count":33,"alternative-id":["10.3389\/fmed.2024.1387043"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2024.1387043","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,3]]},"article-number":"1387043"}}