Symptom Profiles and Anatomical Distribution of Deep Infiltrating Endometriosis

Endometriosis is known to affect women worldwide, and most commonly involves chronic pelvic pain and infertility. Deep infiltrating endometriosis (DIE) is a condition that may involve the bladder, ureter, and bowel. In our study, we evaluated symptoms and locations of endometrial lesions in patients with DIE to improve efficiency in management.

Data were collected retrospectively from electronic medical records (Epic EHR; Epic Systems, Verona, USA) at the United Medical Doctors General and Colorectal Surgery Clinic in La Jolla, San Diego, California, USA. We analyzed 22 patients with an average age at diagnosis of 33.6 years. We utilized frequency distribution and heat maps to summarize endometriosis lesion locations.

In our sample of 22 patients, the most common site of endometrial lesions was the bowel, and only three patients had a positive colonoscopy. Lesion burden was found to be the most significant in the pelvic peritoneum/ligaments. Abdominal pain was reported to be the most common symptom across multiple anatomical sites, followed by dyschezia, constipation, and painful menstrual cramps. Additionally, gastrointestinal symptoms, including nausea, diarrhea, and pain with bowel movements, occurred most frequently in patients with bowel, pelvic peritoneum, and ovarian lesions.

The most common symptoms observed in this study are also seen in many gastrointestinal disorders, highlighting the importance of considering DIE as a potential diagnosis in patients with bowel symptoms. Future research should focus on prospective multicenter studies to validate imaging protocols for DIE and to better differentiate related gynecological and gastrointestinal symptomology.