Clinical Pearls for Management of Colorectal Deep Infiltrating Endometriosis

Endometriosis is an inflammatory condition defined by the presence of endometrium-like tissue outside the uterus. Deep lesions are characterized by the presence of endometrial implants, fibrosis and muscular hyperplasia, affecting 15-30% of the women suffering from endometriosis. Colorectal disease represents almost 90% of these cases. Clinical presentation includes; cyclic bowel alterations, dyschezia and rectal bleeding. Rectal stenosis was observed in 26.4%. Preoperative imaging is crucial in determining the appropriate surgical intervention with transvaginal ultrasound and MRI. Surgical intervention depends on the size and number of lesions and can include rectal shaving, discoid excision, and resection anastomosis. Multidisciplinary surgical management with a team including a  gynecologist with expertise in endometriosis and a colorectal surgeon is key to achieving the best outcomes.