Bowel endometriosis: from pathogenesis to clinical management

Fabio Barra, Barra F, Edoardo G. Giannini, Giannini EG, Edoardo Giovanni Giannini, Centurioni MG, Maria Grazia Centurioni, Gustavino C, Claudio Gustavino, Alessandri F, Franco Alessandri, Ferrero S, Simone Ferrero
The lancet. Gastroenterology & hepatology · 2026 · vol. 11(10) , pp. 925–942 · doi:10.1016/s2468-1253(26)00117-2 · PMID:42398514 · W7167211858
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-07-14 ⓘ

Bowel endometriosis, affecting 8-12% of women, involves complex pathogenesis, a wide range of symptoms, delayed diagnosis, and is managed with imaging, medical therapy, or surgery based on individual needs.

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Abstract

Bowel involvement is a severe manifestation of deep endometriosis that affects approximately 8-12% of women with endometriosis. Bowel endometriosis is most commonly localised in the rectosigmoid colon and frequently coexists with other pelvic lesions. The pathogenesis of bowel endometriosis is multifactorial, involving hormonal, inflammatory, immune, genetic, and anatomical factors. Clinical presentation ranges from asymptomatic disease to severe gastrointestinal and pelvic symptoms, which can mimic other digestive disorders such as irritable bowel syndrome and inflammatory bowel disease. Diagnostic delays frequently exceed 7-10 years. Transvaginal ultrasound and MRI are the main non-invasive tools for the diagnosis and preoperative assessment of rectosigmoid endometriosis. First-line medical therapy with combined oral contraceptives or progestogens might provide symptom control but is not curative, whereas surgery is reserved for bowel obstruction or severe or refractory symptoms, with surgical approach tailored to disease characteristics and patient needs. Fertility outcomes remain uncertain, and the complexity of long-term management, including the rare risk of malignant transformation, supports the need for multidisciplinary follow-up.

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MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (100)

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