{"paper_id":"a554d1f7-ed14-48d6-9ec4-7b85635c6779","body_text":"Analysis of the Characteristics of Intestinal\nEndometriosis Lesions with Rectal Involvement\nUsing Three-Dimensional Endorectal\nUltrasound /C3\nGraziela Olivia da Silva Fernandes 1 Yana de Sousa Crispim Pavan 1 Rosilma Gorete Lima Barreto 1\nNikolay Coelho da Mota 1 Maura Tarciany Coutinho Cajazeiras Oliveira 1\nRaissa Scarlet Queiroz Fernandes 1 Marcelo Travassos Pinto 1 Bruno Barreto Figueiredo Soares 1\n1 Coloproctology Service, Hospital Universitário da Universidade\nFederal do Maranhão (HU-UFMA), São Luís, MA, Brazil\nJ Coloproctol 2026;46(1):s00461817784.\nAddress for correspondence Yana S. C. Pavan, Serviço de\nColoproctologia, Hospital Universitário da Universidade Federal do\nMaranhão (HU-UFMA), Rua dos Bicudos 5, Renascença, São Luís, MA,\n65075 –090, Brazil\n(e-mails: yanapavan22@gmail.com; yanapavan@hotmail.com).\nKeywords\n► bowel endometriosis\n► deep endometriosis\n► 3D endorectal\nultrasound\nAbstract Objective To evaluate the characteristics of endometriosis lesions affecting the\nrectum, using three-dimensional (3D) endorectal ultrasound.\nMaterials and Methods Retrospective, observational, cross-sectional study, with\ndata obtained through the evaluation of elec tronic medical records of patients treated\nat the Coloproctology Service of the Unive rsity Hospital of Universidade Federal do\nMaranhão (HU-UFMA). All patients assessed w ere referred for ultrasound evaluation of\nthe rectum due to suspected lesions in another previous imaging study. Patients\nunderwent 3D endorectal ultrasound examination from May 2017 to May 2024. The\nevaluated data included lesion location, degree of lesion depth in the rectal wall,\nlongitudinal and axial length of the lesion, and its distance from the anal margin.\nResults The sample consisted of 69 patients with a total of 72 foci. All lesions found\nwere in the anterior hemicircumference of the rectum. The most common location of\nthe foci was the middle (25) and upper (27) recta, with 8 foci also found in the lower\nrectum. Six patients had foci in more than one segment. Of the 72 foci found, the\nmajority (39) involved the muscularis pro pria of the rectum. Regarding the length of\nthe longest axis of the lesion, in the longitudinal plane the average was 1.84 cm and in\nthe axial plane the average was 1.86 cm. The lesions were on average 9.0 cm from the\nanal margin.\nConclusion Intestinal endometriosis lesions predominate in the middle and upper\nrecta, approximately 9.0 cm from the anal margin, and mostly involve the muscularis\npropria of the rectum.\n/C3 Study developed at the Coloproctology Service, Hospital Universi-\ntário da Universidade Federal do Maranhão (HU-UFMA) São Luís,\nMA, Brazil, and presented in the 72nd Brazilian Congress of\nColoproctology, in 2024.\nreceived\nApril 9, 2025\naccepted after revision\nNovember 10, 2025\nDOI https://doi.org/\n10.1055/s-0046-1817784.\nISSN 2237-9363.\nEditor-in-Chief :H e n r i q u e\nFillmann.\n© 2026. The Author(s).\nThis is an open access article published by Thieme under the terms of the\nCreative Commons Attribution 4.0 International License, permitting copying\nand reproduction so long as the original work is given appropriate credit\n(https://creativecommons.org/licenses/by/4.0/)\nThieme Revinter Publicações Ltda., Rua Rego Freitas, 175, loja 1,\nRepública, São Paulo, SP, CEP 01220-010, Brazil\nTHIEME\nOriginal Article 1\nArticle published online: 2026-05-05\n\nIntroduction\nEndometriosis is a gynecological disease, characterized by\nthe presence and growth of endometrial tissue outside the\nuterine cavity, affecting approximately 10 to 15% of women\nof reproductive age. Intestinal involvement occurs in 3 to 37%\nof cases of deep endometriosis, representing one of the most\ncomplex and challenging forms of this condition.\n1,2 Intesti-\nnal involvement presents a characteristic anatomical distri-\nbution, with a prevalence of 85% in the rectum and sigmoid,\nfollowed by the terminal ileum (7%), appendix (5%), and\ncecum (3%). This distribution has important clinical signi fi-\ncance, as it directly in fluences the symptomatologic presen-\ntation and therapeutic approach.\n2\nThe pathophysiology of intestinal endometriosis involves\na chronic inflammatory process that can result in progressive\nfibrosis and structural changes in the intestinal wall. Lesions\ntypically progress from the serosa toward the mucosa, with a\ncharacteristic in filtration pattern that respects the layered\narchitecture of the organ. This biological behavior results in\ndifferent degrees of tissue invasion, ranging from super ficial\ninvolvement to complete transmural invasion.\n3\nThe clinical presentation is heterogeneous and frequent-\nly overlaps with other functional gastrointestinal condi-\ntions. The most prevalent symptoms include dysmenorrhea\n(79%), chronic pelvic pain (69%), dyspareunia (45%), and\ncyclical intestinal changes such as pain during defecation\n(29%), constipation (28%), and rectal bleeding (15%). The\nnon-specific nature of these symptoms contributes to an\naverage diagnostic delay of 7 years from the onset of\nsymptoms.\n2,4,5\nAccurate diagnosis and detailed characterization of\nlesions are fundamental for adequate therapeutic planning.\nRecent advances in prepared transvaginal ultrasound (TVUS)\nand prepared magnetic resonance imaging (MRI) protocols\nhave signi ficantly improved diagnostic accuracy, although\nlimitations remain for rectal wall characterization.\nIn this context, three-dimensional endorectal ultrasound\n3D (ERUS) emerges as a complementary tool. It allows\ndetailed visualization of rectal wall layers, the extent of\ninvasion, lesion size, and distance from the anal margin.\nThese findings support surgical planning, including decisions\nbetween segmental resection and more conservative options\nsuch as discoid resection or shaving.\n2,6\nThe diagnostic accuracy of 3D ERUS has been consistently\ndemonstrated in the literature, with a sensitivity of 97% and\nspecificity of 96% for detecting rectal lesions, surpassing\nother imaging methods in assessing the depth of invasion\nin the rectal wall. Additionally, the method offers practical\nadvantages such as good tolerability and absence of exposure\nto ionizing radiation.\n4\nThe precise characterization of rectal endometriotic\nlesions also has important prognostic implications. Lesions\nwith deep in filtration of the rectal wall (beyond the muscu-\nlaris propria) are associated with a higher risk of surgical\ncomplications and a greater likelihood of requiring segmen-\ntal resection. On the other hand, super ficial lesions may be\ncandidates for more conservative techniques such as discoid\nresection, highlighting the importance of precise preopera-\ntive staging.\n2\nThe objective of the present study was to evaluate the\ncharacteristics of endometriosis lesions affecting the rectum,\nusing 3D ERUS.\nMaterials and Methods\nThe present is a retrospective, observational cross-sectional\nstudy, with data obtained through the evaluation of elec -\ntronic medical records, using the University Hospitals Man-\nagement Application (Aplicativo de Gestão para Hospitais\nUniversitários, AGHU, in Portuguese), of patients treated at\nthe Coloproctology Service of Hospital Universitário da Uni-\nversidade Federal do Maranhão (HU-UFMA). The study was\nconducted in accordance with the required ethical standards\nand approved by the Research Ethics Committee of HU-\nUFMA, in accordance with the attributions de fined in Reso-\nlution nr. 466/2012 of the Brazilian National Health Council\n(Conselho Nacional de Saúde, CNS, in Portuguese) and CNS\nOperational Standard nr. 001 of 2013, under CAAE:\n86250825.1.0000.5086.\nPatients underwent 3D ERUS examination from May 2017\nto May 2024. The inclusion criteria were women aged 18 to\n49 years with suspected intestinal endometriosis based on\nclinical symptoms (dysmenorrhea, pelvic pain, dyspareunia,\npainful defecation, rectal bleeding, constipation) and con-\nfirmed by previous imaging (TVUS and/or MRI).\nThe BK Medical Flex-Focus (GE HealthCare) equipment\nwas used. Patients were examined in the left lateral decubi-\ntus position and underwent one rectal enema 2 hours before\nthe examination. After digital rectal examination, the probe\nwas introduced up to 14 cm from the anal margin, and\nsubsequently, scans were performed from proximal to distal.\nProcedures were performed without anesthetic sedation, as\ntolerance was good with only rectal preparation.\nTo ensure homogeneity in the study population and\nreduce bias, patients with associated anorectal conditions\nsuch as in flammatory bowel disease, anorectal cancer, and\npatients who had undergone previous pelvic radiation were\nexcluded.\nThe evaluated data included lesion location (lower, rec -\ntum, or upper rectum), degree of lesion depth in the rectal\nwall, longitudinal length of the lesion, axial length of the\nlesion, and distance of the lesion from the anal margin. All\nevaluations were made on multiplanar images. Two planes\nwere used simultaneously to minimize errors. The final\nsample consisted of 69 patients with intestinal endometri-\nosis. Three patients were excluded because rectal involve-\nment was not visualized on endorectal ultrasound, leaving\n66 patients in the study.\nThe anal canal was systematically evaluated during probe\ninsertion and withdrawal; no endometriotic foci were iden-\ntified in this region.\nThe creation of the database and spreadsheets for statis-\ntical analysis, tables, and graphs was carried out with the\nhelp of GraphPadPrism (GraphPad Software) and Microsoft\nExcel (Microsoft Corp.) applications.\nJ Coloproctol Vol. 46 No. 1/2026 © 2026. The Author(s).\n3D Endorectal Ultrasound for Intestinal Endometriosis Lesions Fernandes et al.2\n\n\nResults\nThe current study evaluated 69 patients diagnosed with\nintestinal endometriosis, with 3 of them being excluded\nfor not presenting visible focus on 3D ERUS, thus resulting\nin a final sample of 66 patients. The mean age of the patients\nwas 37.4 (range: 18 –49) years.\nA total of 72 foci were found. Regarding the location of the\nfoci, all lesions found were in the anterior hemicircumfer-\nence of the rectum (\n►Fig. 1). As for height, the most common\nlocations of the foci were the middle (30) and upper (32)\nrecta, with 10 foci also being found in the lower rectum\n(\n►Fig. 2 ).\nSix patients had foci in more than one segment (one with\nfoci in the lower and middle recta; one in the lower and upper\nrecta, and four in the middle and upper recta).\nRegarding the depth of infiltration in the rectal wall, of the\n72 foci found, the majority (39) involved the muscularis\npropria of the rectum (\n►Fig. 3 ). Twenty-four affected the\nperirectal fat, 6 reached the submucosa, and 3 reached the\nmuscularis mucosa ( ►Fig. 4 ).\nIn the evaluation, the average length of the longest axis of\nthe lesion, in the longitudinal plane, was 1.84 cm (0.37 –\n3.5 cm), and in the axial plane the average was 1.86 cm\n(1.12–4.25 cm). In terms of distance from the anal margin,\nthe lesions were on average 9.0 cm from it ( ►Fig. 5 ).\nDiscussion\nDeep endometriosis with intestinal involvement represents\na signi ficant challenge both in diagnosis and therapeutic\nmanagement. Studies show that intestinal involvement\noccurs in up to 37% of cases of deep endometriosis, with\nthe rectum and rectosigmoid junction being the most fre-\nquently affected segments.\n1,3\nThe mean age of patients in the current study was 37.4\nyears. Of the studies evaluated on the topic, 8 reported the\nmean age of patients, resulting in a general average ranging\nFig. 1 Endometriosis focus evaluated by three-dimensional endor-\nectal ultrasound (axial view) affecting the anterior circumference of\nthe rectum.\nFig. 2 Distribution by rectal segment.\nFig. 3 Endometriosis focus evaluated by three-dimensional endor-\nectal ultrasound (axial view) involving the muscular layer of the\nrectum.\nFig. 4 Depth of lesion invasion.\nJ Coloproctol Vol. 46 No. 1/2026 © 2026. The Author(s).\n3D Endorectal Ultrasound for Intestinal Endometriosis Lesions Fernandes et al. 3\n\n\nfrom 27.8 to 36.8 years. These data are consistent with the\nepidemiology of the disease, which has incidence and prev-\nalence concentrated in women of reproductive age. 1\nDiagnostic precision is fundamental for adequate therapeu-\ntic planning. In this context, 3D ERUS has emerged as a\npromising tool, demonstrating high sensitivity and specificity\nin the detection and characterization of rectal lesions. Recent\nstudies, such as that by Broch et al.,\n7 involving 120 patients\nwith suspected deep endometriosis, of whom 60 underwent\n3D ERUS, showed a signi ficant correlation between the find-\nings of 3D ERUS and videolaparoscopic surgical findings.\nThe work of Lunardelli et al., 8 which compared the histo-\npathological findings of 40 patients with deep endometriosis\npreviously subjected to 3D ERUS, concluded that 72.5% of\npatients had concordance between the examination findings\nand the anatomopathological report. Grif fiths et al.,\n9 in a\nsimilar study, evaluated 32 women who underwent 3D ERUS\nshowing endometriotic focus in the rectovaginal septum,\nwho were subsequently subjected to therapeutic laparosco-\npy. The results showed a sensitivity and specificity of 78% and\n93%, respectively, concluding that the method is a particu-\nlarly important preoperative test, with high concordance\nbetween ultrasound and histopathological findings.\nIn the present study, of the 66 patients evaluated, 6\n(9.09%) had foci in more than 1 rectal segment. Other studies\nhave also observed patients with multiple foci in the rectal\nwall. Bahr et al.,\n10 for example, evaluated 37 patients using\n3D ERUS, of whom 25 presented only 1 focus, 4 patients\npresented 4 foci, and one presented 3 foci. The work of Mezzi\net al.,\n11 which evaluated 63 patients diagnosed with pelvic\nendometriosis using 3D ERUS, also showed that the method\nmay be able to evidence endometriotic lesions in other pelvic\norgans, not just the rectum. The locations found were: uterus\n(33.3%), pouch of Douglas (31.7%), rectosigmoid junction\n(42.8%), rectovaginal septum (9.5%), ovary (9.5%), and others\n(1.6% had bladder involvement). Of the 63 patients, 4 pre-\nsented multiple focus of endometriosis in the pelvic region.\nThe multifocal involvement pattern of endometriosis is\nobserved in most studies on the topic. Broch et al.\n7 mention\npatients with lesions in the ileum and right colon seen during\nvideolaparoscopy, in addition to nine patients requiring\nappendectomy. Sagae et al.,\n12 in their 2007 study, during\nthe cavity inventory, also identified lesions in other locations\nsuch as ileum, right colon, sigmoid, and appendix. Cazalis\net al., 13 in their analysis involving MRI, 3D ERUS, and TVUS\nevaluation, showed foci distributed in different pelvic struc -\ntures such as the pouch of Douglas, bladder, and uterosacral\nligaments.\nIn the present study, all lesions found were located in the\nanterior hemicircumference of the rectum, corroborating the\nfindings of authors such as Bahr et al.,\n10 who also identi fied\n100% of lesions in this location, with 63% in an anteromedial\nlocation and 37% anterolateral.\nSince there is a scarcity of studies on the use of 3D ERUS to\nassess rectal wall involvement, we compared the depth of the\nlesion with those of other modalities. It is important to note\nthat some studies cited in the literature use endoscopic\nultrasonography, which, although similar, has a distinct\nmethodology from 3D ERUS.\n13\nRegarding the in filtration of focus, Rossi et al. 14 analyzed\nthe ability of endoscopic sonography to predict the depth of\ninvolvement of endometriosis focus in the rectal wall in 38\npatients who underwent the examination and were subse-\nquently subjected to laparoscopic surgery. Their results\nshowed that for the detection of in filtration of the muscular\nlayer by endometriosis, the positive predictive value (PPV) of\n3D ERUS was 100%, while for the detection of\nsubmucosa/mucosa layer involvement, the sensitivity was\n89%, the speci ficity was 26%, the PPV was 55%, the negative\npredictive value (NPV) was 71%, with test accuracy of 58%.\nThus, the analysis concluded that, in 3D ERUS, endometriotic\ninfiltration of the muscular layer can be predicted with\nprecision. However, it is less accurate in detecting submuco-\nsa layer involvement.\nThe present study identi fied greater involvement of the\nmuscularis propria (54.2% of cases), similar to the findings of\nBroch et al.,\n7 who in their work also found a greater number\nof lesions that affected up to the muscularis propria layer of\nthe rectum (24 of the 41 patients with intestinal endometri-\nosis evaluated). Tomiyoshi et al.\n15 corroborate these data,\nshowing, in their analysis, that 44.44% of patients had focus\naffecting the muscular layer of the rectum, followed by 31.4%\nof patients with focus restricted to the perirectal fat, and\nother patients excluded due to lack of data. In contrast, the\nFig. 5 Endometriosis focus (arrows) evaluated by three-dimensional\nendorectal ultrasound (sagittal view) approximately 10 cm from the\nanal margin.\nJ Coloproctol Vol. 46 No. 1/2026 © 2026. The Author(s).\n3D Endorectal Ultrasound for Intestinal Endometriosis Lesions Fernandes et al.4\n\n\nstudy by Sagae et al., 16 published in 2009, shows a more\nheterogeneous distribution of this involvement, evidencing\nthat 75% of patients studied by 3D ERUS had focus restricted\nto the perirectal fat, only 15% with focus involving the\nmuscularis propria, and 10% with focus involving all layers\nof the rectum.\nTomiyoshi et al.,\n15 in their analysis of 63 patients with\nsuspected deep endometriosis, compared the findings of 3D\nERUS with MRI. The authors found almost perfect concor-\ndance for lesions that invaded the muscularis propria of the\nrectum, findings that highlight the similar speci ficity be-\ntween 3D ERUS and the method traditionally considered the\ngold standard (MRI).\nIn accordance with the cited data, a literature review\nconducted by Roseau et al. 17 concluded that when compared\nto other imaging examinations appropriate for diagnosing\ndeep pelvic endometriosis, 3D ERUS is better at diagnosing\ninfiltrations of the rectal wall and the rectovaginal septum,\nwhile MRI and TVUS seem more appropriate for diagnosing\novarian endometriomas and infiltrations of the uterine torus,\nuterosacral ligaments, or bladder.\nPiketty et al.,\n18 comparing the performance of 3D ERUS in\nrelation to TVUS in diagnosing involvement by endometriotic\nfocus in the intestinal wall, noted that the former presented\nsensitivity of 96% and speci ficity of 100% (PPV ¼ 100% and\nNPV ¼ 95.2%), while the latter showed sensitivity of 90.7%\nand speci ficity of 96.5% (PPV ¼ 97.1% and NPV ¼ 88.9%),\nconcluding that both methods present similar degrees of\nprecision for diagnosis.\nThis work also evaluated the size of lesions found in the\nrectum, by measuring the largest axis in the longitudinal\nplane and in the axial plane, finding an average of 1.84 cm\nand 1.86 cm, respectively. When comparing with other stud-\nies, it is noted that there is no signi ficant difference in this\naverage. The study by Lunardelli et al.,\n8 for example, showed\na general average of 2.1 cm. The authors also evaluated the\ndistance of the focus from the sphincter apparatus, finding an\naverage of 4.2 cm. The present study evaluated the distance\nbetween the focus and the anal margin, resulting in an\naverage of 9 cm. When considering that the female anal canal\ncan vary from 2.5 to 4 cm in length, associating with the\nfindings of Lunardelli’s study,\n8 we note that the focus tends to\npredominate in the middle and upper rectum.\nTechnical Aspects and Clinical Implications\nThe comparative analysis of these studies reveals some\nimportant points:\n1. Diagnostic accuracy: 3D ERUS consistently demonstrates\nhigh sensitivity and specificity for detecting rectal lesions,\nespecially when there is invasion of the muscularis prop-\nria, a finding con firmed in all analyzed series.\n2. Pattern of involvement: There is a clear predominance of\nlesions in the anterior hemicircumference of the rectum\nand in the middle and upper portions, a pattern observed\nin different studies.\n3. Multimodal validation: The strong concordance between\ndifferent diagnostic methods (3D ERUS, MRI, and video-\nlaparoscopy) reinforces the reliability of 3D ERUS as a\ndiagnostic tool.\nConclusion\nThree-dimensional endorectal ultrasound proved to be an\neffective diagnostic tool in characterizing endometriosis\nlesions with rectal involvement. Intestinal endometriosis\nlesions predominate in the anterior hemicircumference of\nthe middle and upper recta, at an average distance of 9.0 cm\nfrom the anal margin, affecting the muscularis propria layer\nand are less than 2.0 cm in length per plane. The precise\ncharacterization of lesions through 3D ERUS provides impor-\ntant information for de fining the surgical strategy, contrib-\nuting to a more individualized and potentially more effective\napproach in the treatment of intestinal endometriosis.\nData Availability\nData will be available upon request to the corresponding\nauthor.\nFunding\nThe authors declare that they did not receive funding from\nagencies in the public, private or non-pro fit sectors to\nconduct the present study.\nConflict of Interests\nThe authors have no con flict of interests to declare.\nReferences\n1 Abrão MS, Petraglia F, Falcone T, Keckstein J, Osuga Y, Chapron C.\nDeep endometriosis in filtrating the rectosigmoid: critical factors\nto consider before management. Hum Reprod Update 2015;21\n(03):329–339. Doi: 10.1093/humupd/dmv003\n2 Steele SR, Hull TL, Hyman N, Maykel JA, Read TE, Whitlow CB,\neditors. The ASCRS Textbook of Colon and Rectal Surgery. 4th ed.\nNew York: Springer; 2022. Chapter 45, Endometriosis of the\nColon, Rectum, and Anus; p. 789 –803.\n3 Ferrero S, Camerini G, Maggiore ULR, Venturini PL, Biscaldi E,\nRemorgida V. Bowel endometriosis: Recent insights and unsolved\nproblems. World J Gastrointest Surg 2011;3(23):31 –38. Doi:\n10.4240/wjgs.v3.i3.31\n4 Guerriero S, Saba L, Pascual MA, et al. Transvaginal ultrasound vs\nmagnetic resonance imaging for diagnosing deep in filtrating\nendometriosis: systematic review and meta-analysis. Ultrasound\nObstet Gynecol 2018;51(05):586 –595. Doi: 10.1002/uog.18961\n5 Bazot M, Darai E, Hourani R, et a l. Deep pelvic endometriosis:\nMR imaging for diagnosis and prediction of extension of\ndisease. Radiology 2004;232(02):379 –389. Doi: 10.1148/\nradiol.2322030762\n6 Roman H, Puscasiu L, Lempicki M, et al. Colorectal Endometriosis\nResponsible for Bowel Occlusion or Subocclusion in Women With\nPregnancy Intention: Is the Policy of Primary in Vitro Fertilization\nAlways Safe? J Minim Invasive Gynecol 2015;22(06):1059 –1067.\nDoi: 10.1016/j.jmig.2015.05.023\n7 Broch LR, Lima DMdR, Morais VdS, Yurk TC, Mantovani DdCL.\nCorrelação entre ultrassonogra fia anorretal tridimensional e\nvideolaparoscopia em mulheres com suspeita de endometriose\nprofunda. E-Acadêmica 2023;4(02):e0542446. Doi: 10.52076/\neacad-v4i2.446\n8 Lunardelli MC, Bastos CM, Borba EVCd, Watte G, Lopes RHF,\nOliveira R. Correlação dos achados anatomopatológicos com os\nJ Coloproctol Vol. 46 No. 1/2026 © 2026. The Author(s).\n3D Endorectal Ultrasound for Intestinal Endometriosis Lesions Fernandes et al. 5\n\n\nachados da ultrassonogra fia tridimensional em pacientes com\nendometriose pélvica in filtrativa profunda. Rev Thêma et Scien-\ntia. 2015;5(01):99 –104\n9 Grif fit h sA ,K o u t s o u r i d o uR ,V a u g h a nS ,P e n k e t hR ,R o b e r t sS A ,\nTorkington J. Transrectal ultrasound and the diagnosis of\nrectovaginal endometriosis: a prospective observational study.\nActa Obstet Gynecol Scand 2008;87(04):445 –448. Doi:\n10.1080/00016340801948318\n10 Bahr A, De Parades V, Gadonneix P, et al. Endorectal ultrasonog-\nraphy in predicting rectal wall in filtration in patients with deep\npelvic endometriosis: a modern tool for an ancient disease. Dis\nColon Rectum 2006;49(06):869 –875. Doi: 10.1007/s10350-006-\n0501-x\n11 Mezzi G, Ferrari S, Arcidiacono PG, Di Puppo F, Candiani M, Testoni\nPA. Endoscopic rectal ultrasound and elastosonography are useful\nin flow chart for the diagnosis of deep pelvic endometriosis with\nrectal involvement. J Obstet Gynaecol Res 2011;37(06):586 –590.\nDoi: 10.1111/j.1447-0756.2010.01413.x\n12 Sagae UE, Lopasso FP, Abrão MS, Cavalli N, Rodrigues JJG. Endo-\nmetriose do trato gastrintestinal: correlações clínicas e laparos-\ncópicas. Rev Bras Coloproctol 2007;27(04):423 –431. Doi:\n10.1590/s0101-98802007000400010\n13 Cazalis CG, Koskas M, Martin B, Palazzo L, Madelenat P, Yazbeck C.\n[Preoperative imaging of deeply in filtrating endometriosis in:\nTransvaginal sonography, rectal endoscopic sonography and mag-\nnetic resonance imaging]. Gynecol Obstet Fertil 2012;40(11):\n634–641. Doi: 10.1016/j.gyobfe.2012.09.014\n14 Rossi L, Palazzo L, Yazbeck C, et al. Can rectal endoscopic sonog-\nraphy be used to predict in filtration depth in patients with deep\ninfiltrating endometriosis of the rectum? Ultrasound Obstet\nGynecol 2014;43(03):322 –327. Doi: 10.1002/uog.12535\n15 Tomiyoshi MM, Lima DMdR, Kurachi G, Sagae UE, Emori F,\nBazzano B. Correlation between findings of nuclear magnetic\nresonance and 3D anorectal ultrasound in patients with sus-\npected deep endometriosis. J Coloproctol (Rio J) 2020;40(03):\n243–246. Doi: 10.1016/j.jcol.2020.05.015\n16 Sagae UE, Lima DMdR, Cavalli N, et al. Importância da ultra-\nsonografia anorretal tridimensional na decisão terapêutica da\nendometriose profunda. Rev Bras Coloproctol 2009;29(04):\n435–442. Doi: 10.1590/S0101-98802009000400001\n17 Roseau G. Recto-sigmoid endoscopic -ultrasonography in the\nstaging of deep in filtrating endometriosis. World J Gastrointest\nEndosc 2014;6(11):525 –533. Doi: 10.4253/wjge.v6.i11.525\n18 Piketty M, Chopin N, Dousset B, et al. Preoperative work-up for\npatients with deeply in filtrating endometriosis: transvaginal\nultrasonography must de finitely be the first-line imaging exami-\nnation. Hum Reprod 2009;24(03):602 –607. Doi: 10.1093/hum-\nrep/den405\nJ Coloproctol Vol. 46 No. 1/2026 © 2026. The Author(s).\n3D Endorectal Ultrasound for Intestinal Endometriosis Lesions Fernandes et al.6","source_license":"CC0","license_restricted":false}