The Diagnosis and Management of Severe Endometriosis

R Mallick
In: MOJ Surgery · 2017 · vol. 4(5) · doi:10.15406/mojs.2017.04.00087 · W2749631946
article OA: bronze CC0 ⤵ 1 in-corpus citation
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This article reviews current evidence on diagnosing deep infiltrating endometriosis and discusses the benefits, risks, and limitations of various surgical management options.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 ⓘ

This paper reviews the diagnosis and management of severe deep infiltrating endometriosis (DIE), focusing on how clinicians evaluate suspected disease involving the bowel and urinary tract and the range of surgical and medical management considerations. It summarizes evidence on diagnostic performance of imaging modalities (especially transvaginal ultrasound and MRI), notes that definitive diagnosis is often made at laparoscopy, and highlights limitations such as operator dependence and possible under-detection when visualization is limited or surgeon experience affects assessment, with a reported long diagnostic delay after first complaints. It also outlines preoperative planning elements for complex cases, including multidisciplinary referral and imaging to assess bowel, ureter, and bladder involvement, while discussing that medical therapy may be suboptimal with high recurrence after cessation and that urinary tract involvement is relatively uncommon and may require careful surgical strategies, though evidence for some practices (e.g., prophylactic stenting to reduce injury) is limited. This paper is centrally about endometriosis — it specifically appraises diagnostic approaches and management options for severe deep infiltrating endometriosis, including bowel and urinary tract involvement.

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Abstract

The symptoms of endometriosis are very much dependent on the location of the disease however dysmenorrheal, chronic pelvic pain, deep dyspareunia, fatigue, and sub fertility continue to be the leading symptoms. 4 DIE involving the RVS is generally associated with more severe forms of dyschezia and dyspareunia 5 and DIE involving the urinary tract can present with frequency, nocturia, bladder spasms and haematuria. Delay in the diagnosis of endometriosis still remains a problem, with a reported mean time from initial complaint to diagnosis varying from 7.96 to 11.73years. 7 ] In DIE the efficacy of medical treatment is often suboptimal, with high recurrence rates on cessation of treatment Debate and controversy still exists as to how radical surgery should be when excising DIE and its long-term benefits and complications. This aim of this article is to appraise the current evidence for the diagnosis of DIE as well as the various different surgical options available and to discuss their benefits, risks and limitations.

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Condition tags

endometriosisdie_deep_infiltratingchronic_pelvic_paindyspareunia

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.

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last seen: 2026-06-10T17:14:06.276822+00:00
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