Deep endometriosis: Definition, pathogenesis, and clinical management

Paolo Vercellini, Giada Frontino, Giuliana Pietropaolo, Umberto Gattei, Raffaella Daguati, Pier Giorgio Crosignani

Research output: Contribution to journalArticlepeer-review


"Deep endometriosis" includes rectovaginal lesions as well as infiltrative forms that involve vital structures such as bowel, ureters, and bladder. The available evidence suggests the same pathogenesis for deep infiltrating vesical and rectovaginal endometriosis (i.e., intraperitoneal seeding of regurgitated endometrial cells, which collect and implant in the most dependent portions of the peritoneal cavity and the anterior and posterior cul-de-sac, and trigger an inflammatory process leading to adhesion of contiguous organs with creation of false peritoneal bottoms). According to anatomic, surgical, and pathologic findings, deep endometriotic lesions seem to originate intraperitoneally rather than extraperitoneally. Also the lateral asymmetry in the occurrence of ureteral endometriosis is compatible with the menstrual reflux theory and with the anatomic differences of the left and right hemipelvis. Peritoneal, ovarian, and deep endometriosis may be diverse manifestations of a disease with a single origin (i.e., regurgitated endometrium). Based on different pathogenetic hypotheses, several schemes have been proposed to classify deep endometriosis, but further data are needed to demonstrate their validity and reliability. Drugs induce temporary quiescence of active deep lesions and may be useful in selected circumstances. Progestins should be considered as first-line medical treatment for temporary pain relief. However, in most cases of severely infiltrating disease, surgery is the final solution. Great importance must be given to complete and balanced counseling, as awareness of the real possibilities of different treatments will enhance the patient's collaboration.

Original languageEnglish
Pages (from-to)153-161
Number of pages9
JournalAmerican Association of Gynecologic Laparoscopists
Issue number2
Publication statusPublished - May 2004

ASJC Scopus subject areas

  • Obstetrics and Gynaecology


Dive into the research topics of 'Deep endometriosis: Definition, pathogenesis, and clinical management'. Together they form a unique fingerprint.

Cite this