Fig. 15

Failed relief of LBO from SEMS treatment of deep infiltrating endometriosis. Initial upright radiograph (a) showed severe colonic dilatation (*) with prominent air-fluid levels consistent with high-grade obstruction. Axial (b) and sagittal (c) CT images confirmed LBO (*) above a segmental mural thickening (arrowheads) at the rectosigmoid junction, which corresponded at pathology to endometriosis. After SEMS (thick arrows) positioning at an impassable extrinsic stricture 15 cm above the anal verge, radiographic follow-up (d) and CT (e, f) showed persistent LBO (*). Sagittal (e) and MIP (f) CT images showed incomplete expansion of the SEMS (thick arrows). Immediate laparotomy with rectosigmoid resection and temporary stoma was required