Extranodal natural killer-cell lymphoma presenting to the emergency room with abdominal pain: a case report.

Bowel symptoms are frequently reported in patients with endometriosis (up to 37%) [, ], and they may persist, newly occur, or worsen after surgery, even in the absence of major postoperative complications or disease recurrence. In particular, constipation and tenesmus may increase in up to 27% [, ]. While more extensive procedures, particularly segmental colorectal resection, have traditionally been considered at higher risk for postoperative bowel dysfunction, increasing evidence suggests that gastrointestinal impairment is also common following conservative surgery and may already be present preoperatively due to the pathophysiology of deep endometriosis itself []. Therefore, the attribution of postoperative bowel dysfunction just to the extent of surgical resection remains controversial, and the optimal management of these symptoms still represents an unmet clinical need. Postoperative bowel dysfunction after surgery for endometriosis includes a broad spectrum of symptoms that closely remind a low anterior resection syndrome (LARS), a condition well described in rectal cancer surgery. These symptoms include increased stool frequency, urgency, clustering, impaired continence, and difficulty postponing bowel movements. However, recent evidence suggests that LARS-like symptoms are already present in a significant proportion of women with untreated colorectal endometriosis, highlighting the multifactorial pathophysiology of gastrointestinal dysfunction in these patients and complicating the interpretation of postsurgical outcomes [, ]. The mechanisms underlying bowel dysfunction after endometriosis surgery are not completely understood, involving a combination of factors including disruption of autonomic pelvic nerves, altered rectal reservoir function, changes in bowel anatomy, postoperative fibrosis, and persistent visceral hypersensitivity. Moreover, baseline gastrointestinal function, extent of surgery, and surgical technique appear to influence long-term functional outcomes, despite existing studies reporting heterogeneous results, partly due to differences in follow-up duration, outcome measures, and study design [–].