Clinical diagnosis and treatment of bowel endometriosis and the distribution characteristics of lesions

Bowel endometriosis (BE) is a complex condition that can present with diverse clinical manifestations, impacting the quality of life for affected individuals. This retrospective case series aimed to investigate the clinical characteristics, diagnosis, treatment, and lesion distribution of BE. Eighty-eight patients with pathologically confirmed BE who underwent surgery at Shanghai Rui-jin Hospital between January 2013 and September 2024 were retrospectively reviewed. Clinical features, diagnostic methods, treatment approaches, lesion distribution, and their association with adenomyosis were analyzed. Among the 88 patients, 70.5% had unilateral and/or bilateral endometriotic cysts, and 44.4% of those with ureteral involvement had such cysts. Pelvic MRI demonstrated a positive predictive value of 88.2% (60/68), and endoscopic ultrasound (EUS) showed a positive predictive value of 90.2% (37/41) for preoperative diagnosis of BE. Following surgery, all patients reported relief or disappearance of symptoms, with postoperative symptom improvement rates of 100% for dysmenorrhea, chronic pelvic pain, dyspareunia, and dyschezia. Pelvic MRI is recommended for preoperative evaluation of BE, and EUS may be a valuable adjunct in patients with gastrointestinal symptoms to exclude malignancy. CT urography should be considered in cases with suspected ureteral involvement requiring further anatomical clarification. Multidisciplinary collaboration is essential for individualized surgical planning and optimal management of BE.