Bowel endometriosis affects between 3.8% and 37% of women with endometriosis. 
The evaluation of symptoms and clinical examination are inadequate for an 
accurate diagnosis of intestinal endometriosis. Transvaginal ultrasonography is 
the first line investigation in patients with suspected bowel endometriosis and 
allows accurate determination of the presence of the disease. Radiological 
techniques (such as magnetic resonance imaging and multidetector computerized 
tomography enteroclysis) are useful for estimating the extent of bowel 
endometriosis. Hormonal therapies (progestins, gonadotropin releasing hormone 
analogues and aromatase inhibitors) significantly improve pain and intestinal 
symptoms in patients with bowel stenosis less than 60% and who do not wish to 
conceive. However, hormonal therapies may not prevent the progression of bowel 
endometriosis and, therefore, patients receiving long-term treatment should be 
periodically monitored. Surgical excision of bowel endometriosis should be 
offered to symptomatic patients with bowel stenosis greater than 60%. Intestinal 
endometriotic nodules may be excised by nodulectomy or segmental resection. Both 
surgical procedures improve pain, intestinal symptoms and fertility. Nodulectomy 
may be associated with a lower rate of complications.