Deep Pelvic Endometriosis

Endometriosis with extensive deep affectation needs a targeted MR study for an accurate diagnosis and treatment planning. The reported patient had affectation of the three compartments, with solid invasive masses, predominantly fibrous. Since laparoscopy provides limited information on the sub peritoneal extent and presence of endometriotic lesions in areas hidden by adhesions, the non-invasive MR study will allow proper assessment of the whole pelvis and a more accurate global diagnosis of this entity. Compared to transvaginal, endorectal and endoscopic sonography, MR provides the necessary information for proper surgical planning as a map of organ affectation. Structure reporting of endometriosis is extremely important to systematically check each of the structures that may be affected in the different anatomical compartments. However, successful treatment planning may require, as in this case report, laparotomy with two different surgical teams (gynecology and coloproctology) for appropriate end results.