Endometriosis is a chronic gynecological inflammatory condition defined as ectopic endometrial tissue proliferating outside the uterus. It is a frequently underestimated disease affecting 2%–8% of the general population, more than 80% of affected patients are of reproductive age. It is one of the most common causes of life-impacting chronic pelvic pain and female infertility.

Women with this disease usually present with pelvic pain, dysmenorrhea, and dyspareunia, all of which can strongly affect quality of life.

Endometriosis most commonly affects organs of the pelvic cavity (ovaries, fallopian tubes,urinary bladder, intestines or peritoneum) but it can also appear outside de pelvic cavity such as in the diaphragm, pleura or abdominal wall.

Threre are three main entities of pelvic endometriosis: ovarian endometriotic cysts, superficial peritoneal endometriosis, and DIE, defined as the presence of implants extending 5 mm or deeper under the peritoneal surface usually nodular and able to invade adjacent structures, associated with fibrosis and disruption of   normal anatomy. The degree of infiltration of DIE may be correated with the severity of symptoms including pelvic chronic pain, dysmenorrhea, dyspareunia, bowel or bladder dysfunctions and infertility

Endometriosis management requieres a multidisciplinary team discussion evaluating the benefit-risk balance of options, considering complete surgical excision of all DIE lesions when medical treatment has failed. However, surgery may be associated with complications, such as rectovaginal fistula, bladder atony, and bowel perforation. Moreover, such severe complications may also compromise future fertility. 

Transvaginal sonography is the first-line imaging technique to diagnose endometriosis, but magnetic resonance imaging (MRI) is more accurate in staging the extent of lesions, especially for deep infiltrating endometriosis (DIE) giving an exhaustive DIE roadmap, essential in preoperative decision making.

Early diagnosis and precise evaluation of the extent of lesions and severity of adhesions before and after treatment are important for formulating a treatment strategy.