title: Bowel endometriosis: presentation, diagnosis, and treatment.
abstract: Bowel endometriosis opens a new frontier for the gynecologist, as it forces the understanding of a new anatomy, a new physiology, and a new pathology. Although some women with bowel endometriosis may be asymptomatic, the majority of them develop a variety of gastrointestinal complains. No clear guideline exists for the evaluation of patients with suspected bowel endometriosis. Given the fact that, besides rectal nodules, bowel endometriosis can not be diagnosed by physical examination, imaging techniques should be used. Several techniques have been proposed for the diagnosis of bowel endometriosis including double-contrast barium enema, transvaginal ultrasonography, rectal endoscopic ultrasonography, magnetic resonance imaging, and multislice computed tomography enteroclysis. Medical management of bowel endometriosis is currently speculative; expectant management should be carefully balanced with the severity of symptoms and the feasibility of prolonged follow-up. Several studies demonstrated an improvement in quality of life after extensive surgical excision of the disease. Bowel endometriotic nodules can be removed by various techniques: mucosal skinning, nodulectomy, full thickness disc resection, and segmental resection. Although the indications for colorectal resection are controversial, recent data suggest that aggressive surgery improves symptoms and quality of life.
  
  
  BACKGROUND
  Obstetricians & Gynecologists, Family Physicians.
  
  
  OBJECTIVE
  After completion of this article, the reader should be able to describe the varied appearance of bowel endometriosis, recall that it is difficult to diagnose preoperatively, and explain that surgical treatment offers the best treatment in symptomatic patients through a variety of surgical techniques which is best accomplished with a team approach.
authors.affiliation: Department of Obstetrics and Gynaecology, San Martino Hospital and University of Genoa, Genoa, Italy.
authors.forename: Valentino
authors.initials: V
authors.lastname: Remorgida
authors.forename: Simone
authors.initials: S
authors.lastname: Ferrero
authors.forename: Ezio
authors.initials: E
authors.lastname: Fulcheri
authors.forename: Nicola
authors.initials: N
authors.lastname: Ragni
authors.forename: Dan C
authors.initials: DC
authors.lastname: Martin
mesh_terms: D004715:Endometriosis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D014463:Ultrasonography