DIE. Rectal nodule. Bowel resection. Left parametrial nodule. Uretero-neocystostomy.

33 years nullipara, deep infiltrating endometriosis, severe dysmenorheea, severe dyspareunia, bowel disorders (diarrhoea/constipation)

MRI examination

 - adherential lesions that distorts the pelvic anatomy, between the uterus and cervix, rectum, recto-sigmoid junction, both adnexae and bilateral LUS

 - pseudonodular lesion that excentrically infiltrates and stenosing the rectum and the recto-sigmoid junction, starting from about 100 mm of OAE, on a length of 30 mm and a thickness of 14 mm

 - the two lesions come together and obstruct the retrouterine space, more pronounced on the left side

 - infiltration of bilateral uterosacral ligaments and bilateral parameters, especially on the left side;

 - important adhesions at the retrouterine space - tractioning the rectum, recto-sigmoid jonction, sigmoid colon - multiple ansae of the colon at this level;

 - possible left hematosalpinx 

Pelvic endometriosis lesions - stage 4 rASF, Enzian 2A2B1B3CFO

Exploratory laparoscopy reveals a pelvic adherential ‘block’: uterus, both adnexae, sigmoid colon, superior rectum, mid-rectum, posterior vaginal wall, left ureter (drawn at the level of the left parametric node). After dissecting the sigmoid colon, superior rectum, both pelvic ureters and both adnexae, both pararectal spaces and recto-vaginal space, I practiced:

- excision of both parameters - endometriotic lesions

- during the dissection of the left parametrial nodule (infiltrating the left periureteral tissue), a pelvic ureteral lesion is produced (about 3 cm from the bladder) - left ureteral-bladder anastomosis

- colo-rectal resection with T-T intracorporeal anastomosis

- right ovarian cystectomy (endometrioma)