Bowel Endometriosis: What Happens If It’s Found During Surgery?

By Dr. Vincent J. Obias - MD, MS, FASCRS Robotic Colorectal Surgeon, Endometriosis Excision Specialist

If you are planning surgery for endometriosis, you may be asking:

What happens if they find endometriosis on my bowel?

This is a common and important question. Bowel endometriosis can sound frightening, but with the right endometriosis specialist and a coordinated surgical team, it can be treated safely using advanced minimally invasive laparoscopic and robotic techniques.

If you are experiencing symptoms that may involve your bowel, book a consultation to discuss your concerns and get clarity before surgery.

What Is Bowel Endometriosis?

Endometriosis can grow on the rectum, colon, small bowel and appendix.

When it affects the bowel wall, this is called bowel endometriosis.

You may experience:

• Pain with bowel movements, especially during your period
• Deep pelvic pain
• Constipation that worsens cyclically
• Rectal pressure
• Rarely, blood in the stool

Some patients have no bowel symptoms at all.

Small nodules can burrow into the bowel wall and may not always appear clearly on MRI. The most sensitive test is a transvaginal ultrasound performed by an expert in endometriosis. It has an 89 percent chance of detecting rectal nodules.¹

Even so, bowel endometriosis is sometimes discovered during surgery.

What Happens During Surgery?

If bowel endometriosis is found, treatment depends on how deep and how extensive the disease is.

If the Lesion Is Superficial

When the nodule does not go through the full thickness of the bowel wall, it can often be shaved off. The bowel is then repaired with absorbable sutures.

This is typically done using minimally invasive laparoscopic or robotic surgery, which supports faster recovery and less postoperative pain.

If the Lesion Is Deeper

If endometriosis extends through the bowel wall or affects a larger segment, a colorectal surgeon may need to perform:

• Disc excision
• Segmental bowel resection
• Low anterior resection for rectal disease

These are specialized procedures that require experience in both endometriosis and colorectal surgery.

This is why planning matters.

Planning Your Surgery at Washington Endometriosis and Complex Surgery

At Washington Endometriosis and Complex Surgery, bowel endometriosis is not treated as an afterthought.

Patients are evaluated by two fellowship-trained surgeons:

• A specialist in Minimally Invasive Gynecologic Surgery
• A fellowship-trained colorectal surgeon experienced in bowel endometriosis excision

You will have comprehensive appointments to review your imaging, discuss your symptoms, and understand the possible surgical pathways. If bowel involvement is suspected, it is addressed before you enter the operating room.

Your multidisciplinary surgical plan is created in advance and clearly explained to you.

We believe patients deserve:

• A clear understanding of what may be found
• A detailed discussion of surgical options
• Honest conversations about risks and recovery
• A coordinated team prepared for complexity

When both specialists are part of your care plan, you reduce the likelihood of unexpected decisions or repeat surgeries.

If you are looking for an endometriosis specialist who works side by side with a dedicated colorectal surgeon, this integrated approach matters.

Why a Multidisciplinary Approach Improves Outcomes

Bowel endometriosis is not rare in advanced disease. Treating it properly requires collaboration.

At WECS:

• Surgery is performed using minimally invasive laparoscopic or robotic techniques whenever appropriate
• Organ-preserving strategies are prioritized
• Both specialists are present when needed
• The plan is communicated clearly to you before surgery

This preparation improves safety and supports better long-term results.

If you have painful bowel movements during your cycle, persistent pelvic pain, or prior incomplete surgery, it may be time to seek specialized care.

Take the Next Step

You deserve a surgical team that plans ahead, communicates clearly, and respects your questions.

Book an appointment to discuss whether bowel endometriosis may be contributing to your symptoms.

Book a consultation today to learn about your options and create a personalized, multidisciplinary surgical plan with fellowship-trained specialists.

Citation

1. Moura APC, Ribeiro HSAA, Bernardo WM, et al. Accuracy of transvaginal sonography versus MRI in the diagnosis of rectosigmoid endometriosis: systematic review and meta-analysis. PLoS One. 2019.

Dr. Vincent J Obias is one of the nation’s few fellowship-trained colorectal surgeons specializing in endometriosis excision. He completed fellowship training in colorectal surgery at the Cleveland Clinic, followed by advanced laparoscopic colorectal surgery training at Case Western Reserve University. He is board certified in both General Surgery and Colon and Rectal Surgery and is a Fellow of the American Society of Colon and Rectal Surgeons.

Dr. Obias served for more than a decade as Chief of Colon and Rectal Surgery at George Washington University and later as Chief of Colorectal Surgery for the National Capital Region at Johns Hopkins Medicine. He is a former Visiting Professor of Surgery at the University of the Philippines.

A pioneer in robotic colorectal surgery, Dr. Obias performed the first robotic colorectal procedure in Washington, DC in 2009 and has led national and international training in advanced minimally invasive and robotic techniques. His clinical focus includes complex colorectal disease and deep infiltrating endometriosis involving the bowel. Follow him on Instagram

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