Intestinal endometriosis: the gynaecologist, the radiologist and the colo-rectal surgeon as a multidisciplinary team

Deep infiltrating endometriosis (DIE) is defined as infiltration by endometriotic tissue into anatomical structures and organs. Endometriotic tissue is composed of endometrial glands and stroma. DIE is a particular form of endometriosis and it occurs in 30– 40 % of women. Of all forms of intestinal endometriosis, 90% of cases, present with colorectal involvement with a significant impact on the quality of life of these patients. Although the deep infiltrative form of the disease is the most serious, generally being accompanied by severe symptoms at the site of infiltration of the endometriotic foci, no clear guidelines exist for the evaluation of patients with suspected bowel endometriosis. On the basis of recent evidence in literature, intestinal endometriosis is neither diagnosed nor managed in a standardized or appropriate manner. A very high number of patients receive “hit and miss” treatments, often resulting in surgery that does not eradicate the problem. A complete assessment and pre-surgical diagnosis of DIE is crucial. In this work we propose an operative model specifically designed to identify, treat and follow patients affected by intestinal endometriosis. The diagnostic-therapeutic run has to be standardized following a precise sequence of consultations: the gynaecologist must screen patients for DIE and refer them to a dedicated radiologist; the radiologist should both localize intestinal nodules and estimate the relationship between the depth of lesions and the percentage of the circumference of the bowel segment affected by the disease. In our opinion, at this point the patient benefits from a consultation with the colo-rectal surgeon specialized in treating low intestinal pathologies such as cancer or endometriosis. With this work philosophy, different specialists constitute part of an overall solution and treatment plan for each patient to manage their individual symptomatic profile.