Bowel endometriosis: Colorectal surgeon’s perspective in a multidisciplinary surgical team

Figure 1 Transvaginal ultrasound image, sagittal view. A: Hypoechoic nodule in the rectovaginal septum measuring 1 cm × 0.9 cm (arrow). The nodule obliterates the pouch of Douglas, invades the anterior rectal wall, and causes anatomical distorsion (dotted arrow); B: A large hypoechoic retrocervical nodule affecting the rectosigmoid colon is seen (arrow). Note the typical “indian headdress sign”, indicating deep endometriosis into the bowel wall.

Figure 2 Barium enema, sagittal view. A: Extrinsic mass compressing the rectum secondary to severe pelvic endometriosis (arrow); B: Stricture of the sigmoid colon secondary to endometriosis (arrow). Note the fine crenulation of the mucosa (dotted arrow).

Figure 3 Laparoscopic view of bowel endometriosis invading the sigmoid colon (arrow). Same patient as in Figure 2B.

Figure 4 Small bowel adhesions secondary to invasion by endometriosis (arrow).

Figure 5 Segmental enterectomy (8 cm) for small bowel endometriosis. The bowel is cut open longitudinally. Note the two foci of non-transmural endometriosis (arrows) obliterating the bowel lumen.