Advanced Endometriosis with a Large Bowel Nodule Managed Laparoscopically Using the NOSE Technique: a Case Report and Review of Literature

Background Like any other advanced operable disease, advanced endometriosis presents a complex surgical experience to both the patient and the surgical team. This requires advanced surgical skills and the intra-operative time may be prolonged. This exposes the patient to prolonged anesthesia, prolonged carbon dioxide pneumoperitoneum and their associated complications. Consequently, this translates into a slightly increased recovery time and prolonged hospital stay. Case presentation We present a 28-year nulliparous black African diagnosed with advanced endometriosis; Enzian classification P-3 O-2/0 T-3/3 A-0 B-0/0 C-3 FA and was successfully managed laparoscopically using the NOSE technique a rarely performed modality of treatment in this setting. Conclusion Accurate and early diagnosis of endometriosis prevents progression to advanced disease, thereby saving the patientsfrom the burden of extensive and complex surgery. This paper presents an example of a critical diagnostic delay encountered by some endometriosis patients in Uganda. Improving the index of suspicion and diagnostic skills competency especially of performing transvaginal ultrasound scan among gynecology caregivers, coupled with community sensitization about the disease symptoms is paramount in minimizing diagnostic delay.