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.
TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians.
LEARNING OBJECTIVES: 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.