Deep Infiltrating Lesion Identified
Endometriosis tissue invades more than 5mm beneath the peritoneal surface.
- >5 mm: DIE depth threshold (below peritoneum)
- ~20%: Prevalence in endometriosis (of diagnosed cases)
- 3: Common sites (rectum, bladder, septum)
- ~7 yrs: Diagnostic delay (average time to diagnosis)
What defines deep infiltration
Lesions grow past the peritoneal lining into deeper tissue planes.
Symptom pattern
Cyclical pelvic pain, dyschezia, and dyspareunia often signal DIE.
Why depth matters
Deeper lesions raise the odds of organ wall involvement.
Bowel/Bladder Involvement Assessed
Imaging maps how close the lesion sits to nearby organs.
- ~10%: Bowel involvement (of DIE cases)
- ~5%: Bladder involvement (of DIE cases)
- MRI: Preferred imaging (plus transvaginal ultrasound)
- ~90%: Sensitivity (expert US) (for bowel DIE)
Imaging modalities
MRI and expert ultrasound map lesion depth and organ contact.
Bowel wall layers
Involvement is graded by how many bowel wall layers are affected.
Bladder wall assessment
Cystoscopy checks whether lesions reach the bladder mucosa.
Surgical Excision Planning
A multidisciplinary team designs the safest excision approach.
- 3+: Team specialties (gynecology, colorectal, urology)
- 2: Shaving vs resection (main bowel techniques)
- 1–2: Planning meetings (pre-operative case reviews)
- Yes: Bowel prep required (for suspected resection)
Multidisciplinary review
Gynecologic, colorectal, and urologic surgeons align on approach.
Technique selection
Shaving, disc excision, or segmental resection depend on depth.
Patient counseling
Risks of stoma, leak, and fistula are discussed beforehand.
Excision Performed
The lesion is removed, with organ wall repair if needed.
- ~90%: Laparoscopic approach (of DIE excisions)
- ~30%: Bowel wall repair needed (of bowel resections)
- 2–4 h: Average operative time (complex DIE cases)
- ~85%: Complete excision rate (experienced centers)
Excision technique
Instruments dissect lesion tissue free from healthy organ wall.
Wall repair
Sutures close any bowel or bladder wall defect created.
Intraoperative testing
Leak tests confirm repair integrity before closure.
Complication Risk Evaluated
Fistula, leak, and organ injury risk are formally assessed.
- ~2–5%: Anastomotic leak rate (after bowel resection)
- ~1–3%: Rectovaginal fistula (reported incidence)
- ~1%: Bladder injury rate (in expert centers)
- 6 wks: Follow-up window (for complication monitoring)
Fistula risk
Weak repair sites can develop delayed fistula formation.
Leak risk
Anastomotic tension and blood supply drive leak risk.
Long-term monitoring
Follow-up imaging confirms healing and detects recurrence.