Management of deep infiltrative endometriosis (DIE) causing gynecological morbidity: A colorectal surgeon's perspective

Bowel endometriosis is a complex problem for gynecologists and colorectal surgeons alike. The clinical presentation is varied and often deceptive. Symptoms include deep pelvic pain, dysmenorrhea, dyspareunia, dyschezia, tenesmus, and alteration of bowel habit. Severity of the bowel symptoms may vary according to the menstrual cycle. Up to 25% of patients also suffer from infertility. A high index of suspicion is necessary to suspect bowel endometriosis. Transvaginal or transrectal ultrasound and magnetic resonance imaging remain the mainstays of diagnosis. Surgical resection is indicated when symptoms impair quality of life and activities of daily living. The main aim of surgical treatment is the complete removal of all endometriotic deposits on the bowel. Surgical options for deep endometriotic deposits include partial thickness excision or “shave,” full-thickness disc excision, and segmental bowel resection. A multidisciplinary approach is indicated to improve patient outcomes. A laparoscopic approach has made postoperative recovery quicker and safer. Complete surgical excision results in significant improvement in quality of life, fertility, and pain.