Endometriosis is a common benign gynecological disease in women of reproductive age with a variety of clinical presentations ranging from asymptomatic to intractable and intolerance. Intestinal involvement occurs in 3% to 37% of patients with pelvic endometriosis, and rectosigmoid colon is the most frequently involved site . Involvement of the gastrointestinal tract may mimic primary gastrointestinal carcinoma. Bowel obstruction is rare because it usually involves the serous layer, sparing the mucosa. We report a case of a 43-year-old woman presented with gastrointestinal symptoms of bowel obstruction as the first manifestation of disease and highlight the diagnostic difficulty.