Multidisciplinary management of rectal endometriosis: a case report and literature review

Abstract:

Deep infiltrating endometriosis (DIE) is defined as endometriotic lesions infiltrating ≥5 mm beneath the peritoneum, commonly affecting the uterosacral ligaments, rectovaginal septum, vaginal vault, and rectal wall. Due to nonspecific clinical manifestations and atypical imaging features, DIE is often misdiagnosed. This study reports a case of rectal DIE diagnosed preoperatively by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and summarizes the multidisciplinary treatment experience in conjunction with a literature review. A 35-year-old woman was admitted for defecation difficulty. MRI and EUS-FNA confirmed rectal DIE. After multidisciplinary team (MDT) evaluation involving colorectal, gynecologic, and urologic specialists, laparoscopic resection of the rectal lesion, sigmoid-rectal anastomosis, and protective ileostomy were performed. Pathology confirmed rectal DIE with negative margins. The stoma was successfully reversed 4 months later, and no recurrence was observed during 21 months of follow-up. These findings highlight the pivotal role of EUS-FNA in early diagnosis and demonstrate that an MDT approach led by colorectal surgeons can significantly enhance surgical safety and completeness, providing valuable guidance for the individualized management of complex pelvic endometriosis.