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Endometriosis is often seen in gynecology practice and is treated medically. However, intestinal involvement of endometriosis causing acute large bowel obstruction is uncommon and is dif cult to differentiate from malignancy before surgery, owing to its similar colonoscopic and radiologic ndings. We report a successfully-treated case of a 30-year-old woman in which endometrial in ltration of the large bowel caused acute obstruction, requiring emergency surgery to relieve the symptom and conrm the diagnosis. We present this unusual disease in general surgical practice and also review the literature. Keywords: colorectal malignancy, endometriosis, intestinal obstruction