Bowel endometriosis: from pathogenesis to clinical management
Fabio Barra1, Edoardo Giovanni Giannini2, Maria Grazia Centurioni3
1Unit of Obstetrics and Gynecology, IRCCS Azienda Ospedaliera Metropolitana, Genoa, Italy; Department of Health Sciences, University of Genoa, Genoa, Italy.
The Lancet. Gastroenterology & Hepatology
|July 3, 2026
Summary
Deep endometriosis affecting the bowel occurs in 8-12% of women, often in the rectosigmoid colon. Diagnosis is delayed, but ultrasound and MRI aid assessment, with management tailored to symptoms and disease severity.
Area of Science:
- Gynecology
- Gastroenterology
- Surgical Oncology
Background:
- Deep endometriosis affects 8-12% of women, commonly involving the rectosigmoid colon.
- Pathogenesis is multifactorial, including hormonal, inflammatory, immune, genetic, and anatomical factors.
- Symptoms mimic other digestive disorders, leading to diagnostic delays exceeding 7-10 years.
Purpose of the Study:
- To review the current understanding of bowel endometriosis.
- To discuss diagnostic modalities and management strategies.
- To highlight challenges in long-term care and potential complications.
Main Methods:
- Literature review of studies on deep endometriosis and bowel involvement.
- Analysis of diagnostic tools like transvaginal ultrasound and MRI.
- Evaluation of medical and surgical treatment options.
Main Results:
- Rectosigmoid endometriosis is the most common form, often coexisting with pelvic lesions.
- Transvaginal ultrasound and MRI are key non-invasive diagnostic tools.
- Medical therapy offers symptom control; surgery is for severe/refractory cases.
Conclusions:
- Bowel endometriosis requires multidisciplinary management due to complexity and rare malignant transformation risk.
- Timely diagnosis and tailored surgical approaches are crucial.
- Fertility outcomes require further investigation.
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